Clinical Pharmacy Specialist

BlueCross BlueShield of Tennessee

. Support Medicare and D-SNP coverage review activities .

Posted 9/29/2026full-timeRemote • Tennessee • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Pharmacy Operations, including coverage review activities and claims processing, while effectively managing provider relationships and communication. Proficient in utilizing Microsoft Office tools to support documentation and reporting needs.

Highest-signal resume keywords

Pharmacy ExperienceNational Certification as Pharmacy Technician (PTCB)Medical/Pharmacy Terminology KnowledgeMicrosoft Office ProficiencyDecision Making and Problem Solving Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Pharmacy Coverage ReviewClaims ProcessingAuthorization EntryPharmacy Benefit SystemQuality Improvement ActivitiesPharmacy Reports ReviewCase ManagementAppeals HandlingHealthcare Provider EngagementMulti-Project Management

Soft Skills

Excellent Oral CommunicationExcellent Written CommunicationStrong Interpersonal SkillsOrganizational SkillsTeam Player

Certifications & Qualifications

National Certification as Pharmacy Technician (PTCB)

Industry Keywords

MedicareD-SNPPharmacy TerminologyHealthcare ProvidersMember CareClaims IssuesAuditsQuality ImprovementFACETs InquiriesOn-Call Rotations

About the role

Key responsibilities & impact

Support Medicare and D-SNP 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, and weekends when required to ensure adequate coverage

Requirements

What you’ll need

High School Diploma or equivalent
2 years - 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 have the ability 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 in Medical/Pharmacy terminology
Must be available to work Monday-Friday 8AM-6PM EST, with nights and weekends on a rotating basis
May be required to work evenings, holidays and weekends, including on-call rotations

Benefits

Comp & perks

Tools and resources needed to succeed
Growth, creativity, and continuous learning opportunities