Pharmacy Coordinator

Summary:

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

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 the 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:

• High school diploma or equivalent.
• Minimum 3 years of pharmacy experience, preferably in a managed care environment.
• Medicare and/or Medicaid experience preferred.
• Current state’s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both within 30 days of the start date.

Preferred Skills:

• Previous experience in a call center or fast-paced pharmacy answering multi-line phone system preferred.
• Prior experience using analysis tools or systems (e.g., 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.