Opportunity Description
BlueCross BlueShield of Tennessee (BCBST) is expanding its clinical operations team and seeking to hire a **Coverage Review Pharmacist** to help ensure accurate, compliant, and evidence‑based coverage decisions.
In this role, you will leverage your clinical expertise to perform prospective and retrospective coverage reviews, including prior authorizations and appeals, for both self‑administered and provider‑administered medications. You will apply evidence‑based clinical criteria along with state and federal regulatory requirements to ensure accurate, well‑supported coverage determinations and denial rationales.
As a key clinical resource, you’ll collaborate within a knowledgeable and highly organized team environment while working independently to apply sound clinical judgment. The ideal candidate brings a strong background in prior authorization decisioning and coverage reviews, with prior experience using NovoLogix or MHK systems is highly preferred. A solid understanding of ...
In this role, you will leverage your clinical expertise to perform prospective and retrospective coverage reviews, including prior authorizations and appeals, for both self‑administered and provider‑administered medications. You will apply evidence‑based clinical criteria along with state and federal regulatory requirements to ensure accurate, well‑supported coverage determinations and denial rationales.
As a key clinical resource, you’ll collaborate within a knowledgeable and highly organized team environment while working independently to apply sound clinical judgment. The ideal candidate brings a strong background in prior authorization decisioning and coverage reviews, with prior experience using NovoLogix or MHK systems is highly preferred. A solid understanding of ...
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