BlueCross BlueShield of Tennessee, Nashville, TN
Coverage Review Pharmacist Nov 2020 –Present
- Performed coverage determination for prescription drugs utilizing BCBST criteria, approved clinical compendia, and clinical judgment on prior authorizations, tier exceptions, quantity limit exception, non-formulary exception, and other prescription coverage services
- Perform clinical literature searches to support coverage determination decision
- Collaborate with colleagues to discuss BCBST policies and procedures
- Review member grievance on previously denied medication coverage
Experience using Novologix, Medhok(MHK), FACETs, ESI, ESD, Coverage 360 (c360), Microsoft (Word, Excel, Powerpoint, Outlook, SharePoint, Teams
