Clinical Pharmacy Specialist

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Commercial and Exchange coverage review activities.

You will collaborate with pharmacists and providers to build cases and contribute to coverage determinations that impact member care in a remote environment. The role emphasizes strong organizational skills, attention to detail, and the ability to navigate complex information.

Qualifications

• High School Diploma or equivalent.
• 2 years of pharmacy experience required.
• Certification as Pharmacy Technician (PTCB) preferred.

Responsibilities

• Enter authorizations and test claims in the PBM system to ensure proper adjudication.
• Handle calls from providers/members to support coverage determinations and appeals.
• Monitor emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues.
• Review daily pharmacy reports to ensure appropriate claims processing.
• Assist with departmental audits and quality improvement activities.
• Possibility to work evenings, holidays and weekends to ensure adequate coverage.

Skills

PTCB Certified

MS Office

Communication skills

Team player

Independent work

Pharmacy terminology

Education

High School Diploma or equivalent

Job description

We are hiring a Clinical Pharmacy Specialist at BCBST! In this role, you will support Commercial and Exchange coverage review activities, helping ensure members receive timely and appropriate access to pharmacy benefits and services. You’ll work closely with pharmacists and healthcare providers to build and manage cases, contributing to important coverage determinations that directly impact member care and health outcomes. You will contribute to team success by balancing independent work with collaboration across the pharmacy team. This role offers the opportunity to develop specialized knowledge in coverage review while serving as a key resource in the review process. You’ll engage with providers, manage multiple priorities, and play an important part in delivering high-quality service to both members and providers. To be successful in this position, you’ll bring strong computer and organizational skills, attention to detail, and the ability to navigate complex information in a remote environment. Ideal candidates will have experience in Medicare, Medicaid, retail pharmacy, or managed care settings. Previous experience with coverage review processes will help support a smoother transition into the role. We foster a culture where innovation is encouraged, supporting employees with the tools and resources needed to succeed while promoting growth, creativity, and continuous learning. Note: Schedule: Monday-Friday 8AM-630PM EST, must be available to work nights and weekends on a rotating basis

Job Responsibilities

• Enter authorizations and test claims into the pharmacy benefit system to ensure appropriate claim adjudication.
• Handle incoming and outgoing phone calls from providers and/or members/members representatives to assist in completing coverage determinations and appeals.
• Monitor and answer emails and FACETs inquiries from internal customers regarding pharmacy reviews, appeals, claims issues, etc.
• Review daily pharmacy reports to ensure appropriate claims processing.
• Assist with departmental audits and quality improvement activities.
• May be required to work evenings, holidays and weekends to ensure adequate coverage to meet the business needs including on call rotations

Job Qualifications

Education

High School Diploma or equivalent

Experience

2 years - Pharmacy experience required

Skills & Certifications

• National Certification as Pharmacy Technician (PTCB)
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Proven decision making and problem solving skills
• Ability to work independently and with minimal supervision
• Knowledge in Medical/Pharmacy terminology

Number of Openings Available

1

Worker Type

Employee

Company

BCBST BlueCross BlueShield of Tennessee, Inc.

EEO Policy

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.

About BCBST

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

Remote & Location

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.