Clinical - Pharmacy Coordinator 1 - 210120

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 52,000 - 75,000; Full time

Job summary

Spectraforce Technologies is seeking a Pharmacy Coordinator 1 for a remote, nationally sourced assignment. The role supports the pharmacy program within the health plan, handling prior authorizations, formulary processes, and provider communications.

The position requires 3+ years of pharmacy experience, preferably in managed care, with Medicare/Medicaid exposure. A Pharmacy Technician license is preferred and strong MS Office skills are essential.

Qualifications

• High school diploma or equivalent.
• 3+ years of pharmacy experience, preferably in a managed care environment.
• Current state's Pharmacy Technician license preferred.
• Medicare/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.
• Complies with all policies and standards.

Skills

Pharmacy Technician exp

MS Office

Independent work

Education

High school diploma

Job description

Position Title: Pharmacy Coordinator 1

Work Location: Remote - Nationally sourced

Assignment Duration: 6 months

Work Schedule: Monday - Friday (8 AM to 4:30 PM). No overtime and we can be flexible on the start/end time.

Work Arrangement: Remote

Position Summary:

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

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.
• Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.).
• Experience in the implementation of quality process improvement efforts.
• Experience documenting requirements, creating training materials and working directly with end users.
• License/Certificate: Current state's Pharmacy Technician license preferred.

Candidate Requirements

Education/Certification

Required: high school diploma

Preferred:

Licensure

Required:

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.

Top 3 must-have hard skills stack-ranked by importance

1. Pharmacy Technician experience (open to PBM, retail, or other various experience)
2. Microsoft Office Experience - Excel, Word, Outlook, Visio
3. Ability to work independent and keep good communication with about their project/assignment updates.