Pharmacy Services Specialist – Remote (NC)

Motion Recruitment; North Carolina; Remote; USD 90,000 - 130,000; Full time

Job summary

Motion Recruitment client in the health insurance sector seeks a Pharmacy Services Specialist for remote work in NC. The role involves coordinating pharmacy benefit management operations and supporting clinical and contractual initiatives.

Ideal candidates have 5+ years in the field, PBM experience and RX claims knowledge. The position requires strong coordination with internal teams and external partners to resolve claims and drive program improvements.

Qualifications

• 5+ years of experience in related field.

Responsibilities

• Coordinates daily operations of pharmacy benefit management.
• Supports staff and coordinates research, development, implementation and evaluation of programs.
• Acts as SME for assigned initiatives to provide input on pharmacy needs and projects.
• Resolves issues and escalates to management as appropriate; assists with clinical and contractual issues.
• Coordinates review, implementation and QA of benefit plan administration with internal stakeholders and PBM account team.
• Responds to and coordinates review of vendor inquiries and grievances with PBM, including pharmacy claim adjustments.
• Coordinates resolution of Pharmacy Coverage Determinations with Clinical Staff or external partners.
• Coordinates resolution of pharmacy claim reconsiderations and appeals with Appeals department or external partners.
• Responds to and coordinates review and approval of RFPs, government program applications.

Tools

PBM exp

RX claims

Hard wired internet

Job description

Motion Recruitment client in the health insurance sector seeks a Pharmacy Services Specialist for remote work in NC. The role involves coordinating pharmacy benefit management operations and supporting clinical and contractual initiatives.

Ideal candidates have 5+ years in the field, PBM experience and RX claims knowledge. The position requires strong coordination with internal teams and external partners to resolve claims and drive program improvements.