Clinical Pharmacy Specialist

BlueCross BlueShield of Tennessee

. Support Commercial and Exchange coverage review activities .

Posted 10/27/2026full-timeRemote • Tennessee • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy operations, including coverage review, claims processing, and provider engagement. Proficient in managing multiple priorities while ensuring quality improvement and compliance with pharmacy regulations.

Highest-signal resume keywords

Pharmacy ExperienceNational Certification As Pharmacy Technician (PTCB)Claims ProcessingMicrosoft Office ProficiencyMedical/Pharmacy Terminology Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingPharmacy Benefit SystemCoverage DeterminationsPharmacy Reports ReviewAuthorization Entry

Soft Skills

Excellent Oral CommunicationExcellent Written CommunicationStrong Interpersonal SkillsOrganizational SkillsDecision-Making Skills

Tools & Technologies

Microsoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft PowerPoint

Certifications & Qualifications

National Certification As Pharmacy Technician (PTCB)

Industry Keywords

Pharmacy Coverage ReviewHealthcare Providers EngagementQuality Improvement ActivitiesDepartmental AuditsFACETs Inquiries

About the role

Key responsibilities & impact

Support Commercial and Exchange coverage review activities
Build and manage cases with pharmacists and healthcare providers
Contribute to coverage determinations affecting member care and health outcomes
Engage with providers and manage multiple priorities
Enter authorizations and test claims into the pharmacy benefit system
Handle incoming and outgoing calls from providers, members, and member representatives
Monitor and answer emails and FACETs inquiries regarding pharmacy reviews, appeals, and claims issues
Review daily pharmacy reports to ensure appropriate claims processing
Assist with departmental audits and quality improvement activities
Work evenings, holidays, weekends, and on-call rotations as needed to meet business needs

Requirements

What you’ll need

High School Diploma or equivalent
2 years of pharmacy experience required
National Certification as Pharmacy Technician (PTCB)
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Must be a team player, be organized and able to handle multiple projects
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Proven decision-making and problem-solving skills
Ability to work independently and with minimal supervision
Knowledge of medical/pharmacy terminology
Must be available to work Monday-Friday 8AM-6:30PM EST, with nights and weekends on a rotating basis

Benefits

Comp & perks

Tools and resources needed to succeed
Growth opportunities
Creativity and continuous learning support