Clinical Pharmacy Specialist

🔥 4 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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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

• 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 and manage multiple priorities • Enter authorizations and test claims into the pharmacy benefit system • Handle incoming and outgoing calls from providers, members, and member representatives • Monitor and answer emails and FACETs inquiries regarding pharmacy reviews, appeals, and claims issues • Review daily pharmacy reports to ensure appropriate claims processing • Assist with departmental audits and quality improvement activities • Work evenings, holidays, weekends, and on-call rotations as needed to meet business needs

🎯 Requirements

• High School Diploma or equivalent • 2 years of 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 able 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 of medical/pharmacy terminology • Must be available to work Monday-Friday 8AM-6:30PM EST, with nights and weekends on a rotating basis

🏖️ Benefits

• Tools and resources needed to succeed • Growth opportunities • Creativity and continuous learning support