Pharmacy Coordinator

Summary:

• Location: 100% Remote - National
• Duration: 6 months, possible extension
• Shift: Monday – Friday (8 AM to 4:30 PM). No overtime, flexible start/end time.

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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements:

• Required Education: High school diploma.
• Years of experience required: Minimum 3 years of Pharmacy Technician experience (open to PBM, retail, or other various experience).
• Disqualifiers: No Pharmacy experience.

Preferred Skills:

• Prefer a Pharmacy Technician License but not required.
• Experience with Microsoft Office – Excel, Word, Outlook, Visio.
• Ability to work independently and maintain good communication about project/assignment updates.
• Ability to multitask and properly prioritize work.
• Experience with projects or assignments that require attention to detail.