Medication Management Specialist

Capital Health Plan; Tallahassee (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health coverage

Dental insurance

PTO

Disability insurance

Retirement plan

Life and AD&D insurance

Voluntary life and AD&D insurance

Employee assistance program

SmartDollar

Job summary

Capital Health Plan in Tallahassee, FL is seeking a full-time Medication Management Specialist to oversee regulatory compliance, utilization management, and formulary governance for physician-administered and specialty medications.

You will collaborate with clinical teams, providers, and CHP's benefit partners to ensure evidence-based decisions, accurate data, and preparation for audits; this role supports accreditation and patient-centered care.

Qualifications

• Familiarity with HIPAA regulations and patient privacy requirements.
• Ability to read and interpret clinical and regulatory documents.
• Experience supporting data validation and audit readiness.

Responsibilities

• Oversee regulatory and accreditation requirements related to the pharmacy benefit.
• Conduct utilization management reviews for physician-administered and specialty medications.
• Collaborate with clinical teams, providers, and PBM partners to ensure compliant, evidence-based decisions.

Skills

HIPAA compliance

Clinical communication

Data interpretation

Regulatory understanding

Education

RN/LPN or CPhT/RPhT certification

2-year college/technical degree or 1+ years experience

Tools

Microsoft Office

Internal database software

Job description

Join Capital Health Plan as a full-time Medication Management Specialist to maintain regulatory compliance and ensure we can continue to serve our patients' healthcare needs.

Aside from earning competitive pay, you'll enjoy the following:

• Health coverage and dental insurance
• Health and dependent care spending accounts
• Short and long-term disability
• Major disability time off (MDTO)
• Retirement plan
• Life and AD&D insurance
• Voluntary life and AD&D insurance
• Paid time off (PTO)
• Employee assistance program
• SmartDollar

Keep reading to learn how you can grow your career with our Tallahassee, FL team!

MEDICATION MANAGEMENT SPECIALIST: YOUR IMPACT

Accuracy and attention to detail are crucial in this role, as you'll be directly overseeing the regulatory and accreditation requirements related to the pharmacy benefit.

The Medication Management Specialist conducts utilization management reviews for physician-administered and specialty medications covered under the medical benefit, ensuring requests are reviewed in accordance with evidence-based clinical criteria, benefit requirements, and applicable regulatory guidelines. This role collaborates closely with internal clinical teams, providers, and delegated pharmacy benefit partners to promote quality, compliance, and effective medication management for CHP members. You'll ensure that all activities comply with regulations, maintain departmental files, and participate in timely data validation for internal and external audits. You'll also provide oversight for pharmacy benefit manager delegated functions such as formulary administration and coverage determinations.

SCHEDULE

Our Medication Management Specialist works from 8:00 am - 5:00 pm, Monday - Friday, with some weekend, evening, holiday, or after-hours work as needed.

REQUIREMENTS

Our ideal Medication Management Specialist has at least 4 years of related experience in a Medicare Advantage or commercially managed care environment. What matters most is that you have:

• Valid Florida RN, LPN, or pharmacy technician (CPhT/RPhT) certification
• 2-year college/technical school degree OR 1+ years of related experience/training OR an equivalent combination of education and experience
• Knowledge and understanding of HIPAA regulations, clinical patient care, various diseases and medications, regulatory/accreditation requirements, and pharmacy benefit management
• Strong language skills for effectively reading, analyzing, interpreting, and writing professional journals, technical documents, business reports, and procedure manuals
• Effective verbal/written communication and presentation skills for engaging with managers, clients, and the public
• General math skills (addition, subtraction, multiplication, division, fractions, decimals, ratios, bar graphs, etc.)
• High-level reasoning, problem-solving, and clinical research skills
• Proficiency in Microsoft Office, internal database software, and document/statistic production
• Ability to perform the physical duties of the role, including frequently reaching, using hands/fingers/arms, bending, climbing stairs, and crouching

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OUR MISSION

We are a not-for-profit health care organization that has served the panhandle since 1982, delivering high-quality, affordable, and patient-centered care. Our employees are essential to our continued success, and their passion, motivation, and commitment drive our reputation for excellence and member satisfaction.

Whether delivering direct care, supporting patients, or ensuring smooth operations behind the scenes, every team member plays a vital role in fulfilling our mission to improve the health of our communities. We are dedicated to fostering a professional, respectful, and inclusive workplace where employees are valued, supported in their growth, and empowered to make a meaningful impact.

CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

Must have the ability to pass a background check and drug screening test.