Pharmacy Coordinator

Summary:

• Work Mode: 100% Remote Nationwide
• Duration: 4 months, No extension or conversion
• SHIFT: M-F 8am-5pm EST

Responsibilities:

• Conduct outbound outreach to members, providers, and pharmacies to support pharmacy quality initiatives focused on medication adherence, high-risk medication use, and appropriate therapy measures.
• 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Education: High school diploma or equivalent required.
• Licensure: Pharmacy Technician license preferred.
• Disqualifiers: Poor communication/customer service skills.

Preferred Skills:

• Medicare/Quality experience preferred.
• Advanced Microsoft Office experience preferred (Excel, Word, Teams, Outlook).
• Customer service experience.

Top 3 Must-Have Hard Skills:

• Pharmacy experience, preferably in a managed care or retail environment.
• Excellent verbal and written communication skills.