Coverage Review Pharmacist

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

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

• Perform prospective and retrospective coverage reviews and appeals per State and Federal regulations • Serve as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision • Maintain denial rationale associated with clinical criteria • Ensure decision letters meet regulatory compliance and guidance • Participate in alternating team on-call rotation

🎯 Requirements

• Doctor of Pharmacy (PharmD) Degree • 3 years of clinical experience required, and/or completion of 1 year residency and/or board certification • 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, organized, and able 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 • Licensed in Tennessee to practice Pharmacy, or eligible for licensure in Tennessee within 120 days of employment