Coverage Review Pharmacist

Job Title

BCBST BlueCross BlueShield of Tennessee, Inc.

Job Duties & Responsibilities

Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations.

Serves as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision.

Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance and guidance.

Participates in alternating team on-call rotation.

Job Qualifications

Education

Doctor of Pharmacy (PharmD) Degree

Experience

3 years - Clinical experience required, and/or completion of 1 year residency and/or board certification

Skills/Certifications

Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.

Competency in compendia navigation and research

Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)

Must be a team player, be organized and able to handle multiple projects

Excellent oral and written communication skills

Strong interpersonal and organizational skills

Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required

Knowledge of medical and pharmacy products

License

Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy within 120 days of employment

Number of Openings Available

1

Worker Type:

Employee

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

BlueCross BlueShield of Tennessee