Title: Pharmacy Services Specialist
Duration: 6 months
Location: The role is 100% remote, but candidates need to be from an approved conversion State (Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.)

Job Description:

• Provides daily coordination of activities related to the operations of pharmacy benefit management.
• Provides support to staff and coordinates tasks regarding the research, development, implementation, and evaluation of programs, projects, and initiatives.
• Serves as a resource to staff and subject matter expert for assigned initiatives to provide input regarding pharmacy needs, impacts, and projects.
• Resolves issues and escalates to management as appropriate, assists management in addressing clinical and contractual issues.
• Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
• Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing making pharmacy claim adjustments as appropriate.
• Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff andor external partners as appropriate.
• Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
• Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.

Hiring Requirements:

• High school diploma or GED.
• 3 years of experience in related field.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 24.91/hr.