Responsible for various activities associated with coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member grievances focused on medications. Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations. Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods. Builds and maintains decision trees in the prior authorization system. Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance.
Top Skills Details: PharmD, Medicare Coverage, and/or Prior Authorization Experience
Additional Skills & Qualifications:
Skills/Certifications - Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Experience Level Intermediate Level Setting 100% Remote - MUST reside within 2 hours of Chattanooga, TN Job Type & Location This is a Contract position based out of Chattanooga, TN. Pay and Benefits The pay range for this position is $67.48 - $67.48/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Workplace Type This is a fully remote position.
Application Deadline This position is anticipated to close on Dec 1, 2025.
About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalantaccommodation@actalentservices.com for other accommodation options.
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