Remote Clinical Pharmacy Specialist — Coverage Review

BlueCross BlueShield of Tennessee; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members have timely access to pharmacy benefits and services.

This remote-friendly role collaborates with pharmacists and providers to manage cases and decisions impacting member care. The ideal candidate brings Medicare/Medicaid or managed care experience, strong computer skills, and attention to detail in a remote environment.

Qualifications

• 2 years of pharmacy experience
• Medicare/Medicaid or managed care experience preferred
• Experience navigating remote environments

Responsibilities

• Enter authorizations and test claims into the pharmacy benefit system
• Handle calls from providers/members to assist in coverage determinations and appeals
• Monitor emails and FACETs inquiries from internal customers about reviews and claims issues
• Review daily pharmacy reports to ensure proper claims processing
• Assist with audits and quality improvement activities
• May work evenings, holidays and weekends for coverage

Skills

PTCB Certification

Microsoft Office

Teamwork

Oral and Written Communications

Interpersonal Skills

Decision Making

Independent Work

Pharmacy Terminology

Education

High School Diploma or equivalent

Job description

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members have timely access to pharmacy benefits and services.

This remote-friendly role collaborates with pharmacists and providers to manage cases and decisions impacting member care. The ideal candidate brings Medicare/Medicaid or managed care experience, strong computer skills, and attention to detail in a remote environment.