Remote Pharmacy Programs & Compliance Specialist

Socket.dev; United States; On-site; USD 54,000 - 70,000; Full time

Benefits offered by this job

ESPP

Office setup reimbursement

Monthly cell phone & internet stipend

Remote-first culture

Paid parental leave

Job summary

Clover Health is seeking a Pharmacy Programs Specialist to support Medicare Part D quality metrics and medication management while ensuring CMS compliance. You will validate claim adjudication, provide telephone support to plan members, prescribers, and pharmacies, and document activity in EMR systems.

Success includes integrating into the Pharmacy team, ensuring accurate Part D benefits, and driving process improvements across cross-functional partners.

Qualifications

• Pharmacist with National Certification (CPhT) preferred.
• At least three years of experience in pharmacy, managed care, medical office or hospital setting.
• Fluent in English and Spanish, both oral and written.
• Understanding of managed care and CMS guidelines.
• Proficient with Windows-based applications and general software.
• Excellent written and verbal communication skills.
• Willingness to work Eastern Time hours.

Responsibilities

• Create, manage, and respond to cases; escalate to Clinical Pharmacists as needed.
• Help improve Part D Star measures by addressing medication management root causes.
• Represent the Pharmacy team in cross-functional meetings and data reviews.
• Collect and present data/trends from PBM-delegated functions to workgroups.
• Lead educational training on Part D knowledge and vendor platforms.

Skills

Case management

Root cause analysis

Cross-functional collaboration

Data analysis

Communication

Education

National Certification (CPhT) Pharmacy Technician License

Job description

Clover Health is seeking a Pharmacy Programs Specialist to support Medicare Part D quality metrics and medication management while ensuring CMS compliance. You will validate claim adjudication, provide telephone support to plan members, prescribers, and pharmacies, and document activity in EMR systems.

Success includes integrating into the Pharmacy team, ensuring accurate Part D benefits, and driving process improvements across cross-functional partners.