Pharmacy Analytics & Programs Specialist

Community Health Choice, Inc.; Houston (TX); Hybrid; USD 60,000 - 75,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Pharmacy Program Specialist in the Pharmacy Analytics department.

You will provide efficient responses to external customers and internal team members, resolve outpatient pharmacy benefit coverage and prescription claim problems, and communicate formulary guidelines, prior authorization criteria, and group/member eligibility problems. Under the direction of the Director of Pharmacy Analytics, you will assist with prior authorizations, monitor PBM

Qualifications

• Education/Specialized Training/Licensure: HS Diploma or GED.
• Registered with the Texas State Board of Pharmacy as a pharmacy technician and in good standing (CPhT) required.
• Bachelor's degree preferred.
• Work Experience (Years and Area): 1 year in related functions required.
• Minimum of 1 year experience with a health plan or PBM preferred.
• Software Proficiencies: Microsoft Office.

Responsibilities

• Assist with processing medication prior authorization and appeal requests within required turn-around time.
• Monitor and process medication override requests-Communicate authorization and medication approval to Pharmacy Benefit Manager within required turn-around time.
• Answer questions regarding pharmacy benefit and coverage of medical injectables under medical benefit.
• Resolve coverage issues with Pharmacy Benefit Manager pertaining covered drugs, copays, medication prior authorization requests and medication appeals.
• Make outreach to members and providers as directed to improve medication adherence.
• Assist with generating reports and perform monitoring over delegated PBM functions as directed.
• Make outreach to members and providers as directed to resolve issues with medical requests within required turn-around time.
• Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plan, and other duties as assigned.

Education

HS Diploma or GED

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Community Health Choice, Inc. is seeking a Pharmacy Program Specialist in the Pharmacy Analytics department.

You will provide efficient responses to external customers and internal team members, resolve outpatient pharmacy benefit coverage and prescription claim problems, and communicate formulary guidelines, prior authorization criteria, and group/member eligibility problems. Under the direction of the Director of Pharmacy Analytics, you will assist with prior authorizations, monitor PBM