Coverage Review Pharmacist

Remote

USA, TN, Chattanooga, Remote

Full time

R 51087

** Job

Duties & Responsibilities *
* + Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations
+ Serves as a clinical resource to aid in solving basic to mid level reviews with limited assistance and supervision
+ Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance and guidance
+ 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 Power Point  
+ 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 Blue Cross Blue Shield of Tennessee, Inc

** Applying for this job indicates your acknowledgement and understanding of the following statements:*
* BCBST will 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 BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices  (Use the "Apply for this Job" box below). bcbst com/docs/equal employment opportunity pdf

** Blue Cross Blue Shield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity  All resumes submitted by search firms to any employee at Blue Cross Blue Shield of Tennessee via email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from Blue Cross Blue Shield of Tennessee HR/Talent Acquisition will not be considered  No fee will be paid in the event the applicant is hired by Blue Cross Blue Shield of Tennessee as a result of the referral or through other means *
* As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945  More than that, we're 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

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members  We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability

We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously  Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST

We foster a culture where innovation is encouraged  That includes using AI enabled tools responsibly to support everyday work - guided by proven workflows, templates, and policies  As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members

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 position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance