Clinical - Pharmacy Coordinator 1 - 210120

Remote - Nationally Sourced, prefer candidates located in PST with Remote work experience

Monday Friday (8 AM to 4 : 30 PM).

No overtime and flexible on the start / end time.

Duration : 6+ months

Job Description :

Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Education / Experience :

High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and / or Medicaid experience preferred.

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.

Typical Day in the Role

• Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
• What are the performance expectations / metrics?
• What makes this role unique?

Create DT loaders in Excel that will be uploaded to MHK / Compass platform.

Configure decision tools into the MHK / Compass platform.

Conduct testing to ensure decision tools are proper functioning.

Update decision tools to align with integration of client.

Follow training instructions and complete training sessions in a timely manner.

Expectation will be to maintain high-quality level work.

Pay close attention to details.

Complete monthly configuration on time.

Candidate Requirements

Education / Certification

Required : high school diploma

Preferred : Licensure

Required : NA

Preferred : prefer a Pharmacy Technician License but not required.

Years of experience required : 3+ years of Pharmacy Technician experience (open to PBM, retail, or other various experience)

Disqualifiers :

Additional qualities to look for : Ability to multitask or properly prioritize work, Experience with projects or assignments that require attention to details.

Pharmacy Technician experience (open to PBM, retail, or other various experience)

Microsoft Office Experience Excel, Word, Outlook, Visio

Ability to work independent and keep good communication with about their project / assignment updates.