Clinical Pharmacy Specialist

🔥 3 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• 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/member 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 • Work evenings, holidays and weekends as needed to ensure adequate business coverage, including on-call rotations • Support Commercial and Exchange coverage review activities • Build and manage cases with pharmacists and healthcare providers • Contribute to coverage determinations affecting member care and health outcomes • Engage with providers, manage multiple priorities, and deliver high-quality service to members and providers

🎯 Requirements

• High School Diploma or equivalent • 2 years - Pharmacy experience required • 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 • Must be available to work Monday-Friday 8AM-6:30PM EST • Must be available to work nights and weekends on a rotating basis • May be required to work evenings, holidays and weekends, including on-call rotations

🏖️ Benefits

• Tools and resources needed to succeed • Growth, creativity, and continuous learning opportunities