Pharmacy Benefits & Utilization Coordinator

Maryland-Care-Management-Inc; Linthicum (MD); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Term Life Insurance

Disability insurance

401k Employer Match

Paid Time Off

Tuition assistance

Job summary

Maryland Care Management, Inc. (MCMI) is seeking a Pharmacy Benefit Coordinator to support clinical outreach services for members, pharmacies, and healthcare providers.

The role aims to ensure member safety, reduce gaps in care, identify cost-effective medication strategies, and coordinate care to improve outcomes. You will support HEDIS initiatives and work with the Pharmacy Management team to manage PBM vendor collaboration, utilization review, quality improvement, and population health

Qualifications

• PBM programs understanding and practices.
• Identify and resolve member/provider/process issues, with written recommendations.
• Business writing and report generation skills.
• Attention to detail in benefits and codes interpretation.
• Regulatory awareness and interdependent regulatory impact.

Responsibilities

• Support HEDIS adherence projects with quality management.
• Implement and code pharmacy benefits, formulary, and program changes; review PBM tests.
• Review pharmacy services recommended for denial and investigate data from plan providers.
• Assist in gathering information from plan providers and pharmacy data systems.
• Support utilization management, quality improvement, provider relations, and population health initiatives.
• Act as a pharmacy liaison to plan pharmacies and members.
• Assist Pharmacist in monitoring and evaluating pharmacy utilization.

Skills

PBM programs understanding

Findings communication

Business writing & reports

Attention to detail

Regulatory familiarity

Education

High school diploma/GED

Maryland Pharmacy Technician license

2 years pharmacy technician experience

Job description

Maryland Care Management, Inc. (MCMI) is seeking a Pharmacy Benefit Coordinator to support clinical outreach services for members, pharmacies, and healthcare providers.

The role aims to ensure member safety, reduce gaps in care, identify cost-effective medication strategies, and coordinate care to improve outcomes. You will support HEDIS initiatives and work with the Pharmacy Management team to manage PBM vendor collaboration, utilization review, quality improvement, and population health