Remote Pharmacy Programs Specialist — Part D & CMS

Clover Health; Northern (KY); Hybrid; USD 54,000 - 70,000; Full time

Benefits offered by this job

Remote-first culture

Competitive salary

401k matching

Performance bonus

Paid parental leave

ESPP

Job summary

Clover Health in the United States seeks a Pharmacy Programs Specialist to support Medicare Part D quality metrics, medication management initiatives, and CMS compliance standards.

You will validate claim adjudication to ensure access to care, perform telephonic outreach to plan members, prescribers, and pharmacies, and document activity in electronic medical records while collaborating with clinical pharmacists and cross‑functional teams.

Qualifications

• Active National Certification (CPhT) preferred.
• Minimum three years of pharmacy, managed care, medical office, or hospital experience.

Responsibilities

• Validate claim adjudication to ensure access to care.
• Provide telephonic outreach to plan members, providers, and pharmacies.
• Collaborate with Clinical Pharmacists and cross‑functional teams on medication management initiatives.
• Prepare and present data trends to support CMS quality metrics.

Skills

CPhT Certification

Pharmacy experience

Bilingual English/Spanish

CMS/Medicare knowledge

Windows PC skills

Job description

Clover Health in the United States seeks a Pharmacy Programs Specialist to support Medicare Part D quality metrics, medication management initiatives, and CMS compliance standards.

You will validate claim adjudication to ensure access to care, perform telephonic outreach to plan members, prescribers, and pharmacies, and document activity in electronic medical records while collaborating with clinical pharmacists and cross‑functional teams.