Job Summary
We are seeking a dedicated and detail-oriented Pharmacy Coordinator to oversee daily pharmacy operations within a healthcare setting.
Duties
- Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
- The Pharmacy Coordinator will 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
- The Pharmacy Coordinator will 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
- The Pharmacy Coordinator will Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
Qualifications
- Pharm tech license required
- 3+ years pharmacy technician/pharmacy operations experience (managed care and/or quality/outreach experience strongly preferred).
- Confident communicating with provider offices/pharmacies and members/guardians
- Experience with HEDIS/Stars measures and medication adherence interventions
- Pharmacy technician operations expertise (including medication access support such as prior auth/formulary navigation).
- Advanced Excel/report skills (filtering/sorting, data cleanup) and ability to build/maintain trackers and summarize results.
- Quality measure/HEDIS outreach workflow experience (interpreting measure gap lists, executing member/provider/pharmacy outreach, and documenting outcomes).
#INDPW
Pay: $22.94 per hour
Benefits:
- Dental insurance
- Health insurance
- Vision insurance
Application Question(s):
- Monday-Friday, 8:30am-5:00pm ET (flex as needed for outreach/operational needs). Occasional OT may be required during peak measure cycles.
License/Certification:
- IN - Pharmacy Tech License (Required)
Location:
Work Location: Remote
