Coverage Review Pharmacist

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); On-site; USD 100,000 - 140,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. in Chattanooga, TN is seeking a Pharmacist to perform prospective and retrospective coverage reviews and appeals in line with State and Federal regulations. The role requires a PharmD and at least 3 years of clinical experience, or completion of a residency/board certification. License in Tennessee or eligibility within 120 days is required. The position supports independent work and team collaboration.

Qualifications

• Doctor of Pharmacy (PharmD) degree required.
• 3 years of clinical experience required, and/or completion of 1 year residency and/or board certification.
• Licensed in Tennessee to practice Pharmacy, or eligible for licensure in Tennessee within 120 days of employment.

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 letters meet regulatory guidance.
• Participates in alternating team on-call rotation.

Skills

Compendia navigation

Research skills

Microsoft Office

Communication skills

Team player

Regulatory knowledge

Education

PharmD

Job description

Job Duties & ResponsibilitiesPerforms 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 QualificationsEducationDoctor of Pharmacy (PharmD) DegreeExperience3 years - Clinical experience required, and/or completion of 1 year residency and/or board certificationSkills\CertificationsAbility to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.Competency in compendia navigation and researchProficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)Must be a team player, be organized and able to to handle multiple projectsExcellent oral and written communication skillsStrong interpersonal and organizational skillsSolid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) requiredKnowledge of medical and pharmacy productsLicenseLicensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy within 120 days of employmentNumber of Openings Available1Worker Type:EmployeeCompany:BCBST BlueCross BlueShield of Tennessee, Inc.Applying for this job indicates your acknowledgement and understanding of the following statements: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/NoticesBlueCross 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.