Job Description
Position Title: Pharmacy Coordinator 1
Work Location: Remote (Indiana preferred)
Assignment Duration: 4 months (Possibility to extend)
Work Arrangement: Remote
Work Schedule: Monday-Friday, 8:30am-5:00pm ET (flex as needed for outreach/operational needs). Occasional OT may be required during peak measure cycles.
Position Summary:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
Background & Context:
Support the Health Plan Pharmacy team by driving pharmacy-related quality measure performance through targeted member/provider/pharmacy outreach, issue resolution, and tracking/reporting.
Key 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
Qualification & Experience:
• High school diploma or equivalent. 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 license and PTCB within 30 days of the start date.
• Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
| 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. | ||||
| 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). | |||
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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: $ 18.00/hr.