Coverage Review Pharmacist
Employment type
Full-time
Work setting
On-site
Location
Chattanooga, TN
Schedule
Day shift
Posted
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Job overview
The Coverage Review Pharmacist performs prospective and retrospective coverage reviews and appeals per state and federal regulations. This role is remote, and compensation is not specified. BlueCross BlueShield of Tennessee is a leading health benefit plan company. This role exists to serve as a clinical resource for solving reviews and ensuring that denial rationales meet regulatory compliance. The pharmacist ensures that clinical criteria are applied correctly to support member access to pharmacy products.
What you'll do
- Perform prospective and retrospective coverage reviews and appeals.
- Serve as a clinical resource to aid in solving basic to mid-level reviews.
- Maintain denial rationale associated with clinical criteria.
- Ensure decision letters meet regulatory compliance and guidance.
- Participate in alternating team on-call rotation.
What we're looking for
- Skills & competencies
- full-timeday shiftremotebcbstpharmacistpharmacycoverage reviewhealthcareclinicaltennessee
- Work arrangement
- Weekend coverage required
Why this role
Requires a PharmD degree and 3 years of clinical experience or residency/board certification.
About the employer
BlueCross BlueShield of Tennessee is hiring for this role. Industry: Offices of All Other Miscellaneous Health Practitioners. Sector: 62.
Additional details
- Industry sector
- 62
- Industry
- Offices of All Other Miscellaneous Health Practitioners
- Occupation code
- 99-9999.99
You'll be redirected to the employer's application page.
Listing ID: 7999e3ee-1eed-40c9-a354-2706557aa35f