Pharmacist, Coverage & Appeals Specialist

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

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.