Coverage Review Pharmacist

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🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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BlueCross BlueShield of Tennessee

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5001 - 10000 employees

Founded 1952

⚕️ Healthcare Insurance

Healthcare 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 and ensure that decision letters meet regulatory compliance and guidance. • Participate in alternating team on-call rotation.

🎯 Requirements

• Doctor of Pharmacy (PharmD) Degree • 3 years - 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, be organized and able to handle multiple projects • Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required • License: Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy within 120 days of employment.

🏖️ Benefits

• Weekend on call shifts • Remote work