Contract Pharmacist: COVERAGE DETERMINATION & APPEALS

POSITION SUMMARY: Responsible for reviewing clinical coverage determination and appeals using Medicare and client specific requirements. Knowledgeable in all aspects of coverage determination and appeals process and assist in meeting clients expectations regarding efficiency, services levels, privacy maintenance and quality decision making. Work as part of the team to meet business unit objectives. The Pharmacist will be responsible for reviewing medication exception request, as well as completing data analysis and various clinical projects.  PRIMARY DUTIES AND RESPONSIBILITIES:  Coverage Determination and Appeals: Review the information provided upon request by utilizing the designated tools (web based) for further research  Coverage Determination and Appeals: Outreach for additional information. May include Pharmacy, Prescribers, Members, etc. as appropriate  Coverage Determination and Appeals: Data Entry (Electronic Database) recording decision making, inputting clinical notation, request for additional information, faxes, summary, etc.  Coverage Determination and Appeals: Training – attending meetings, online job aides, process changes, new initiatives, communication, etc. both formal and informal training EDUCATION: .  Preferred: Masters Doctorate/PharmD  Required: Bachelor of Pharmacy Degree  Required: Licensed Pharmacist in good standing with applicable state board(s)  Experience Required minimum 2 years  REQUIRED SKILLS: In order of importance, list specific skills or talents that a qualified incumbent should possess (i.e., management of large staff, computer applications, subject knowledge, etc.)  1. Organize, prioritize and manage multiple tasks on a regular basis with high level of detail  2. Customer Service internally and externally  3. Adaption to Change Management  4. Computer Knowledge including: Microsoft office products, Windows based operations, data entry and clinical systems  5. Excellent Oral and Written communication skills and interpersonal skills  ***THIS IS A 4 - 6 MONTH CONTRACT POSITION. END CLIENT HAS OFFERED 'PERMANENT' POSITIONS TO CANDIDATES IN THE PAST WHO EXCEEDED EXPECTATIONS***