Remote Pharmacy Program Coordinator

Spectraforce Technologies, Inc.; Raleigh (NC); Remote; USD 52,000 - 75,000; Full time

Job summary

Spectraforce Technologies is seeking a Pharmacy Coordinator 1 for a remote, nationally sourced assignment. The role supports the pharmacy program within the health plan, handling prior authorizations, formulary processes, and provider communications.

The position requires 3+ years of pharmacy experience, preferably in managed care, with Medicare/Medicaid exposure. A Pharmacy Technician license is preferred and strong MS Office skills are essential.

Qualifications

• High school diploma or equivalent.
• 3+ years of pharmacy experience, preferably in a managed care environment.
• Current state's Pharmacy Technician license preferred.
• Medicare/Medicaid experience preferred.

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.

Skills

Pharmacy Technician exp

MS Office

Independent work

Education

High school diploma

Job description

Spectraforce Technologies is seeking a Pharmacy Coordinator 1 for a remote, nationally sourced assignment. The role supports the pharmacy program within the health plan, handling prior authorizations, formulary processes, and provider communications.

The position requires 3+ years of pharmacy experience, preferably in managed care, with Medicare/Medicaid exposure. A Pharmacy Technician license is preferred and strong MS Office skills are essential.