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

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

Demonstrates expertise in pharmacy benefit management, including coverage determinations, appeals, and claims processing. Proficient in communication and organizational skills to effectively support healthcare providers and manage multiple projects.

Highest-signal resume keywords

Pharmacy Benefit ManagementNational Certification As Pharmacy TechnicianMedical/Pharmacy TerminologyMicrosoft Office ProficiencyDecision-Making Skills

ATS Keywords

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Applicant Tracking System Keywords

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

Hard Skills

Pharmacy ExperienceClaims ProcessingCoverage DeterminationsAppeals ManagementAuthorization Entry

Soft Skills

Excellent Communication SkillsStrong Interpersonal SkillsOrganizational SkillsProblem-Solving SkillsTeam Player

Tools & Technologies

Pharmacy Benefit SystemFACETs

Certifications & Qualifications

National Certification As Pharmacy Technician

Industry Keywords

Pharmacy BenefitHealthcare ProvidersQuality ImprovementAuditsMHK Experience

About the role

Key responsibilities & impact

Support Commercial and Exchange coverage review activities
Build and manage pharmacy benefit cases with pharmacists and healthcare providers
Contribute to coverage determinations and appeals
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 rotating on-call shifts 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, 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
Candidates with MHK experience strongly preferred
Must be available Monday-Friday, 8AM-6:30PM EST, and nights and weekends on a rotating basis
Ability to work remotely and navigate complex information in a remote environment

Benefits

Comp & perks

Remote work arrangement
Growth, creativity, and continuous learning support
Tools and resources to succeed
Employee status
Rotating on-call opportunities may include evenings, holidays, and weekends