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Clinical - Pharmacy Coordinator 1 - 210120

Mindlance

Remote-IN, IN(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Biotech and Pharmaceutical, Business Growth, Cadence, Call Centers, Certified Pharmacy Technician (CPhT), Cost Analysis, Customer Experience, Customer Support/Service, Data Cleaning, Detail Oriented, Diversity, Documentation, Establish Priorities, Fax Machines, Formulary, Health Plan, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Providers, High School Diploma, Identify Issues, Improvement Metrics, LAMP (Linux Apache MySQL PHP/Perl/Python), Managed Care, Medicaid, Medicare, Medications, Metrics, Organizational Skills, Performance Metrics, Pharmacy, Problem Solving Skills, Process Improvement, Provider Relations, Quality Management, Quality Metrics, Resolve Customer Issues, Service Level Agreement (SLA), Team Player, Telephone Skills, Time Management, Utilization Management
LOCATION
Remote-IN, IN
POSTED
5 days ago
Job Profile Summary

Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.

For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.

For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.

For Centene Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.

Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process

Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines

Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns

Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team

Assist Provider Relations and various departments with educating providers on the health plan s pharmacy process

Assist with the pharmacy utilization review and reporting process

Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes

Assist with members inquiries related to the formulary process
Performs other duties as assigned

Complies with all policies and standards

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Job Profile Summary

Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.

For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.

For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.

For Centene Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.

Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process

Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines

Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns

Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team

Assist Provider Relations and various departments with educating providers on the health plan s pharmacy process

Assist with the pharmacy utilization review and reporting process

Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes

Assist with members inquiries related to the formulary process
Performs other duties as assigned

Complies with all policies and standards
Story Behind the Need
  • What is the purpose of this team?
  • What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
  • Describe the surrounding team (team culture, work environment, etc.) & key projects.
  • Purpose: Support the Health Plan Pharmacy team by driving pharmacy-related quality measure performance through targeted member/provider/pharmacy outreach, issue resolution (e.g., medication access/Client), and tracking/reporting.
  • Need driver: Increased focus on quality measure support (HEDIS/Stars-related measures, including adherence) and additional outreach volume; this is a new temp resource to help close gaps in care and improve metrics.
  • Team culture & key projects: Fast-paced, collaborative, metric-driven environment with high independence/ownership. Key work includes pulling and managing Excel-based member/provider/pharmacy reports; conducting outreach via phone/letter/fax; partnering with local pharmacies (including support of LAMP program activities); and maintaining trackers with weekly/monthly reporting across multiple measures (e.g., AAF, APM, AAP, UOP, SPC, SPD, and adherence-focused measures).
Typical Day in the Role
  • Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
  • What are performance expectations/metrics?
  • What makes this role unique?
  • Day-to-day: Review assigned quality measure reports (weekly/monthly cadence varies by measure), identify members/providers/pharmacies with open gaps, and execute outreach (calls/letters/faxes) to members/guardians, provider offices, and pharmacies. Document outcomes, troubleshoot medication access barriers (e.g., prior auth status, pharmacy processing issues), and escalate as needed. Maintain measure trackers, summarize outreach results, and communicate updates to the pharmacy/quality team.
  • Performance expectations/metrics: Timely completion of assigned outreach within SLA/cadence; accurate documentation and tracking; volume and quality of outreach attempts; measurable closure of gaps (where applicable) and reduction of outstanding adherence/quality opportunities; responsiveness to internal stakeholders; strong attention to PHI compliance and member experience.
  • What makes it unique: High-visibility work directly tied to quality measure outcomes. Requires an independent contributor who can manage multiple measure workflows at once, build/maintain trackers, and partner externally with providers and pharmacies (including LAMP-related engagement) while supporting members with medication adherence and access issues.
Candidate Requirements
Education/Certification Required: High School Diploma/GED Preferred:
Licensure Required: Pharmacy Technician License Preferred:
Years of experience required: 3+ years pharmacy technician/pharmacy operations experience (managed care and/or quality/outreach experience strongly preferred).
Disqualifiers: No active/eligible Pharmacy Technician license (Indiana); inability to work independently; poor communication/customer service skills; discomfort with outbound outreach to members/providers; inability to use Excel for report review/tracking; non-compliance with PHI/required documentation.
Additional qualities to look for: Highly organized self-starter; strong attention to detail; able to prioritize competing deadlines across multiple measures; confident communicating with provider offices/pharmacies and members/guardians; experience with HEDIS/Stars measures and medication adherence interventions; proactive problem-solver who can identify barriers and escalate appropriately.
  • Top 3 must-have hard skills stack-ranked by importance
 1 Pharmacy technician operations expertise (including medication access support such as prior auth/formulary navigation).
2 Advanced Excel/report skills (filtering/sorting, data cleanup) and ability to build/maintain trackers and summarize results.
3 Quality measure/HEDIS outreach workflow experience (interpreting measure gap lists, executing member/provider/pharmacy outreach, and documenting outcomes).

About the Company

M

Mindlance