Clinical Pharmacy Specialist
BlueCross BlueShield of Tennessee · United States · US
Utilization Review
Remote
Pharmacist
Demand66
Career growth58
Healthcare fit62
Remote potential85
5-year outlook
Likely stable but technician-level compensation with modest upward movement; advancement may come through managed care, prior authorization, quality, or pharmacy operations experience.
Clinical license
Not required
Applicant reach
moderate
Seniority
entry
Employment type
full-time
Date found
2026-10-30
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- Profession fit
- Pharmacist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for PTCB-certified pharmacy technicians or early-career pharmacy professionals who want payer-side coverage review experience. Licensed pharmacists should apply cautiously because the scope and requirements appear below clinical pharmacist level.
Who should apply
PTCB-certified pharmacy technicians with managed care, retail, Medicare, or Medicaid exposure; pharmacy graduates or healthcare graduates seeking entry into payer pharmacy operations; pharmacists deliberately targeting managed care utilization review but aware this is a technician-level role.
CV angle
Frame real pharmacy experience around coverage review, prior authorization, claims adjudication, appeals support, provider communication, Medicare/Medicaid or managed care exposure, PTCB certification, Microsoft Office, and ability to manage high-volume phone/email workflows remotely. Do not present it as clinical pharmacist experience unless you have documented clinical pharmacist duties.
Skills to highlight
- Prior authorization and coverage review
- Pharmacy claims adjudication
- Appeals and coverage determination support
- Managed care/Medicare/Medicaid knowledge
- Provider and member communication
- Medical/pharmacy terminology
- Microsoft Office and pharmacy benefit systems
- Attention to detail and multitasking
Role summary
A remote payer-side pharmacy operations role supporting commercial and exchange coverage reviews, prior authorizations, claims adjudication, appeals, provider/member calls, and pharmacy report monitoring for BlueCross BlueShield of Tennessee.
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