Title: Pharmacy Services Specialist Duration: 6 months Location: The role is 100% remote Candidates must 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., but candidates need to be located within EST. Shift: M-F 8-5 EST
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.
Conduct sourcing events, including development of project work plan, category profile, category strategy, minimum requirements and evaluation criteria, solicitation.
Develop and implement assorted bid documents and requests (i.e. RFP, RFI, RFQ); and manage status reporting and performance metrics of sourcing and category management activities.
Understand, analyze and forecast complex market and industry dynamics and share subject matter expertise and industry knowledge within the established portfolio of products and services.
Partner with stakeholders to source products and services using proven tools, processes, and analytics to drive and achieve business results.
Evaluate analyses of sourcing results from a total cost of ownership perspective and provide optimization recommendations.
Participate in cross-functional teams responsible for complex vendor negotiations, including those that require specialized subject matter expertise, nonstandard risk mitigation solutions, and coordination of multiple arrangements.
Review and lead supplier relationship management and performance within an assigned category.
Proactively establish and foster successful, positive working relationships with vendor personnel.
Drive vendor engagement through formal and informal transactions.
Engage stakeholders to implement and execute vendor relationship management plan.
Coordinate and host vendor business reviews.
Develop, track and manage yearly vendor plans for assigned vendors within the assigned category(ies) and ensure vendor compliance.
Coordinate vendor risk assessments and develop plans to track and address significant risks.
Serve as an escalation point for the business in resolving vendor performance issues. issue resolution.
Manage contracts and collaborate effectively with Corporate Compliance, Legal, Audit and Risk Management and other internal stakeholders for compliance activities to ensure regulatory conditions are met.
Research, analyze and provide data driven recommendations regarding compliance or audit level issue resolution and remediation.
Facilitate and monitor vendor implementation of relevant corrective action plans.
Develop new procedures, training, initiatives, specifications and recommendations for process or policy changes and improvements, as appropriate.
Hiring Requirements:
Bachelor's degree or advanced degree (where required).
5+ years of experience in related field.
In lieu of degree, 7+ years of experience in related field.
Top 3-4 Required Skills:
PBM exp.
Hard wired internet good speed.
Nice to have Skills:
RX Claims
Pharmacy Tech
Prior Authorization (retail)
Detail Oriented
Years of Experience:
3-5 Years of experience.
Breakdown of Duties/Typical Day:
Will have to check the shifts calendar to see where the assignments will be and will be sitting in a queue.
Creating the letters that go out to the doctors to obtain any missing information.
What does the training look like for this role?
Learning how to pull data from faxes to see if it's something they need to upload.
Training is 30-90 days if needed.
It depends on how well the person picks up the information.
Applicant Notices & Disclaimers
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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 pay range is $24.91/hr - $26.58/hr.
