Qualifications

• Doctor of Pharmacy Degree (PharmD) required
• 8+ years in Clinical experience
• 6+ years in a managed care setting
• 4+ years in supervisory or leadership roles
• Strong policy implementation and regulatory expertise
• Proficient in data analysis for performance metrics
• Licensed or eligible for Pharmacy licensure in Tennessee

Responsibilities

• Direct day-to-day operations for prior authorization and appeals programs
• Maintain and enforce clinical coverage policies according to regulatory standards
• Lead and mentor managers and staff to improve service quality
• Monitor utilization trends and appeal outcomes for improvement opportunities
• Collaborate with clinical strategy and compliance teams to align operations
• Ensure compliance with audit standards in documentation and review activities
• Drive enhancements in coverage review processes through technology and best practices

Benefits

• Employee position with BCBST BlueCross BlueShield of Tennessee
• Access to professional development and continuous improvement programs
• Opportunity to influence operational strategies and team dynamics
• Collaborative work environment with cross-functional partnerships
• Focus on innovation through technology adoption in healthcare processes