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Pharmacist - Enterprise Solutions Specialist
2 months ago
About the Role
As a Pharmacist at Global Channel Management, you will play a critical role in the technical design, development, implementation, and support of enterprise solutions. This position requires a strong background in pharmacy and a deep understanding of regulatory guidelines.
Key Responsibilities
- Perform prospective and retrospective coverage reviews and appeals in accordance with State and Federal regulations.
- Respond to prescriber, pharmacy provider, member appeals, grievances, and complaints related to pharmaceutical services within established timeframes.
- Build and maintain decision trees in the prior authorization system.
- Maintain denial rationale associated with clinical criteria and ensure decision letters meet regulatory compliance.
Requirements
- Doctor of Pharmacy (PharmD) degree.
- 3 years of clinical experience, with a preference for coverage review experience.
- Competency in compendia navigation and research.
- Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint).
- Strong interpersonal and organizational skills.
- Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required.
- Knowledge of medical and pharmacy products.
- Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee.
What We Offer
As a Pharmacist at Global Channel Management, you will have the opportunity to work with a talented team of professionals and contribute to the development of innovative solutions. We offer a dynamic and supportive work environment, with opportunities for growth and professional development.
