Pharmaceutical Specialist
1 month ago
Global Channel Management is seeking a highly experienced Pharmaceutical Specialist to join our team. The ideal candidate will have a strong background in the technical design, development, and implementation of enterprise solutions.
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.
- Doctor of Pharmacy (PharmD) Degree.
- At least 8 years of experience in the technical design, development, and implementation of enterprise solutions.
- 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.
As a Pharmaceutical Specialist 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 competitive salary and benefits package, as well as opportunities for professional growth and development.
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