Coverage Review Pharmacist – *Must be Licensed in Tennessee*

Job Responsibilities

Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations
Serves as a clinical resource and drug information specialist to other healthcare providers internally, as needed
Builds and maintains decision trees in the prior authorization system
Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance
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 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

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to 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 BCBSTs EEO Policies/Notices may be found by reviewing the following page:

BCBSTs EEO Policies/Notices (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)

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.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

About Us

As Tennessees largest health benefit plan company, weve been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, were 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.

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 applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.