Responsible for various pharmacy related health plan activities in order to modify prescription utilization and optimize therapeutic outcomes across all lines of business.
BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Assists in development and maintenance of formularies, clinical criteria, and/or drug management processes.
Serves as a clinical resource and drug information specialist to medical, pharmacy, & nursing staff as well as to allied healthcare providers internally and externally.
Receives and responds to prescriber, representative, and member pharmacy prior authorizations, appeals, grievance requests within regulated time periods.
Provides and participates in ongoing maintenance, record keeping and oversight to support NCQA, URAC, and CMS quality and audit readiness on a monthly and quarterly basis.
Doctor of Pharmacy (PharmD) Degree
5 years - Clinical experience required, and/or completion of 1 year residency and/or Board of Pharmacy Specialties certification.
Competency in compendia navigation and research
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles, and accountability.
Must be a team player, be organized and have the ability to handle multiple projects
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS)
Knowledge of medical and pharmacy products
Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
Job Specific Requirements:
Drug information and/or medical policy development experience preferred
Number of Openings Available:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to 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
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
All applicants will be advised that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccine mandate.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.