Pharmacy Coordinator 1

Davita Inc.; Raleigh (NC); Remote; USD 45,000 - 70,000; Full time

Job summary

A leading healthcare company seeks a Pharmacy Coordinator 1 to support its pharmacy department. This remote role involves responding to provider inquiries, tracking pharmacy processes, and ensuring adherence to standards. Candidates should have a high school diploma, relevant pharmacy experience, and strong communication skills.

Qualifications

• 3+ years of pharmacy experience, preferably in managed care.
• Current state's Pharmacy Technician license required.
• Advanced Microsoft Office proficiency preferred.

Responsibilities

• Respond to provider and pharmacy calls regarding the prior authorization process.
• Track and trend overrides to ensure compliance.
• Make outbound calls to manage adherence barriers.

Skills

Communication

Customer Service

Analytical Skills

Education

High school diploma or equivalent

Pharmacy Technician Certification Board (PTCB)

Tools

Microsoft Office

Call Center Systems

Job description

Position Title: Pharmacy Coordinator 1

Work Location: Remote - Sourced Nationally (Team will be making calls based out of EST - prefers candidates from EST)

Assignment Duration: 6 months

Work Schedule: Monday - Friday, 8:30 or 9 am - 6 pm, 8-hour workday, some wiggle room in start time

Work Arrangement: Remote

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

Background & Context:

First day will consist of Introduction to team and Pharmacy systems

Internal/External Groups with which the Candidate will interface: Pharmacy Team, Quality Team, External Provider Groups, External Pharmacies, Members

The team has had success with previous temps across our organization

These adherence calls will help support Medicare star rating

For Ambetter it will assist in quality rating

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

Employee will be responsible for making outbound calls to members, providers, and pharmacies regarding medication refills and for resolution of adherence barriers

Employee will be evaluated on:

of calls made per day/week

of successful fills and 30-90-day conversions

Thorough member follow-up and documentation

Call audits

Qualification & Experience:

High school diploma or equivalent

3+ years of pharmacy experience, preferably in a managed care environment

Medicare and/or Medicaid experience preferred

Previous experience in call center or fast paced pharmacy answering multi-line phone system 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 and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date (for general and Superior Health Plan); Current Arizona Pharmacy Technician license (for Arizona Complete Health); Current state's Pharmacy Technician license preferred (for our organization's Pharmacy Services)

Advanced Microsoft office experience preferred (Excel, Word, Teams, Outlook)

Excellent verbal and written communication skills

Disqualifiers: Poor communication/customer service skills (position will be outbound call-based)

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