Jesse Thompson
Nashville,TN
Summary
Clinical Pharmacist with 7 years of managed care experience specializing in specialty drug coverage, prior authorization, and high-cost case management across Commercial and Medicare populations. Proven ability to evaluate complex clinical cases, member grievances, and support cost-effective therapy optimization. Experienced in clinical policy development, utilization management, and cross-functional collaboration to improve consistency, compliance, and patient outcomes.
Overview
19
19
years of professional experience
Work History
Medicare Coverage Review Pharmacist
Blue Cross Blue Shield of TN
Nashville, TN
01.2025 - Current
- Reviewed and approved/denied 325+ prior authorizations weekly for specialty medications, ensuring alignment with clinical guidelines and cost-containment strategies
- Conducted Quality Assurance audits, ensuring coverage reviews are are consistent with NCQA standards and HEDIS measures
- Managed high-cost cases involving biologics, oncology, or rare disease therapies across medical and pharmacy benefits
- Collaborated with pharmacy team members to develop and implement strategies for continuous improvement in quality of care
Clinical Pharmacy Manager (Execution Team)
BlueCross Blueshield of TN
04.2024 - 01.2025
- Led clinical initiatives to optimize medication management and patient outcomes
- Trained and mentored new team members on current process and policies, ensuring alignment with NCQA standards and regulatory requirements
- Oversaw quality assurance programs to enhance patient safety within pharmacy operations.
- Conducted performance evaluations with staff members, providing constructive feedback to enhance skillsets and performance
- Acted as drug expert providing recommendations to member grievance committee on pharmacy-related cases
Commercial Coverage Review Pharmacist
BlueCross Blueshield Of TN
06.2022 - 04.2024
- Evaluated and decisioned approximately 60 coverage review requests each day
- Maintained consensus library to standardize case decisions across commerical coverage review team
- Assisted in the development of policies and procedures related to pharmacy operations, promoting compliance with legal regulations and best practices
Coverage Review Pharmacist (Contractor)
BlueCross BlueShield Of Tennessee
02.2021 - 06.2022
- Performed approximately 50 coverage determination reviews each day
- Provided exceptions to member's formulary when clinically appropriate
- Pivoted between Commerical and Medicare coverage review teams based on need/case volume
Coverage Determination Clinical Pharmacist
UST Global
07.2018 - 06.2020
- Reviewed 40-50 coverage determination requests per day and made decisions according to member benefits, coverage criteria, and CMS regulations
- Served as primary resource and subject-matter expert pertaining to drug coverage process
- Collaborated on development of medication-specific decision trees to integrate into electronic prior authorization software
Pharmacist
Town and Country Drugs
12.2014 - 07.2018
- Verified prescriptions and provided immunizations
- Collaborated with physicians regarding drug interactions and alternatives
- Performed medication therapy management using Mirixa and Outcomes
- Educated patients on possible drug interactions, potential side effects and optimal methods of administration.
Pharmacy Manager
Sam's Club Pharmacy
08.2012 - 11.2013
- Improved patient satisfaction by providing personalized consultations and medication management services.
- Achieved 30% growth in prescription volume after re-location of store.
- Oversaw procurement processes to ensure adequate stock levels while minimizing waste from expired products.
- Led a team of pharmacists and technicians to deliver exceptional patient care and service.
- Vaccinated patients to provide immunity against influenza, pneumonia and other diseases.
Pharmacist
Walgreens Pharmacy
06.2007 - 06.2012
- Interpreted prescription orders, dispensed medications, and counseled patients in a high volume, fast-paced environment
- Conducted thorough drug utilization reviews to identify potential drug interactions or contraindications, ensuring patient safety
- Administered immunizations and met with patients for medication consultations, effectively improving awareness of pharmacy's health services
Education
PharmD - undefined
University of Mississippi Medical Center
Jackson, MS2007
Bachelor of Science - Pharmaceutical Sciences
University of Mississippi
Oxford, MS2005
Skills
- Seven years experience performing coverage determinations, including prior authorizations, non-formulary drug requests, and evaluating and making recommendations for member grievances
- Pharmacy and Medical benefit knowledge
- Strong clinical background
- Building and testing decision trees in prior authorization system
- Effective communications skills amongst team and providers
- Research and problem solving
- Specialty Drug Management
- High-Cost Case Review
Accomplishments
- Magna Cum Laude Graduate, University of Mississippi
- Eagle Scout
- Chancellor's Honor Roll, University of Mississippi
- Salutatorian, Booneville High School
- Golden Key International Honor Society
Professional Organizations and Training
- Pharmaceutical Compounding Training, PCCA Institute, Houston, TX
- Pharmacy Based Immunization Delivery and Basic Life Support CPR Training
- American Pharmacists Association and Tennessee Pharmacists Association
- Kappa Psi Pharmaceutical Fraternity
Timeline
Medicare Coverage Review Pharmacist
Blue Cross Blue Shield of TN
01.2025 - Current
Clinical Pharmacy Manager (Execution Team)
BlueCross Blueshield of TN
04.2024 - 01.2025
Commercial Coverage Review Pharmacist
BlueCross Blueshield Of TN
06.2022 - 04.2024
Coverage Review Pharmacist (Contractor)
BlueCross BlueShield Of Tennessee
02.2021 - 06.2022
Coverage Determination Clinical Pharmacist
UST Global
07.2018 - 06.2020
Pharmacist
Town and Country Drugs
12.2014 - 07.2018
Pharmacy Manager
Sam's Club Pharmacy
08.2012 - 11.2013
Pharmacist
Walgreens Pharmacy
06.2007 - 06.2012
PharmD - undefined
University of Mississippi Medical Center
Bachelor of Science - Pharmaceutical Sciences
University of Mississippi