Specialty Rx Coordinator

Jobgether; United States; Remote; USD 50,000 - 55,000; Full time

Benefits offered by this job

Medical Insurance

Dental & Vision

PTO

Tuition Reimbursement

EAP

Tech Stipend

Remote Flexibility

Job summary

Jobgether in the United States is seeking a seasoned healthcare operations professional to lead prior authorization, specialty medication coordination, single case agreements, and vendor program management.

You will collect records, document requests, coordinate appeals, update member records, and ensure decisions are communicated accurately across retail and specialty pharmacists, prescribers, and members.

Qualifications

• Bachelor's degree or equivalent professional work experience.
• At least five years of experience in pharmacy/medical benefits and specialty pharmacy.
• Experience with prior authorization management.
• Familiarity with RA, transplant, Hepatitis C, infectious diseases, or oncology meds is a plus.
• Excellent written and verbal communication; able to coordinate with multiple stakeholders.
• Strong organizational skills and attention to detail.
• Ability to meet deadlines in a fast-paced environment.
• Proficient with Microsoft Office; familiarity with claims or member management systems is beneficial.

Responsibilities

• Manage pharmacy and medical prior authorization requests.
• Coordinate specialty and vendor communications and documentation.
• Negotiate and document single case agreements; update member records.
• Assist members with financial concerns about specialty meds.
• Coordinate referrals with third-party vendors and implement programs.
• Review vendor plan language for regulatory compliance.
• Collaborate across departments to develop vendor-related policies.
• Escalate issues and provide status updates to clients and teams.
• Improve workflows and service delivery among members, facilities, and vendors.
• Perform other duties to support medical management and specialty operations.

Skills

Prior Authorization

Communication Skills

Organization

Time Management

Analytical Thinking

Adaptability

Technical Proficiency

Education

Bachelor's degree

Tools

Microsoft Office

QicLink system

Claims systems

Job description

Accountabilities

• Prior Authorization Management: Collect and review pharmacy and medical records for prior authorization requests, helping manage increased workloads and ensuring requests are handled accurately and efficiently.
• Specialty Medication Coordination: Act as a liaison between retail and specialty pharmacies, prescribers, and members to document requests, communicate decisions, coordinate appeals, and address medication-related concerns.
• Single Case Agreements: Arrange and negotiate single case agreements, coordinate pricing, process claims accurately, update member records in the QicLink system, and provide ongoing agreement support.
• Member Financial Assistance: Assist members who express financial concerns about specialty medications and communicate escalated issues to the appropriate teams.
• Vendor Program Coordination: Submit referrals to third-party vendors responsible for specialty carve-out programs and serve as a liaison during program implementation and ongoing operations.
• Contract and Regulatory Compliance: Review existing and proposed vendor plan language to assess its impact under applicable governmental regulations, ensuring continued compliance with contractual requirements throughout the revenue cycle.
• Cross-Functional Collaboration: Work with customer service, plan administration, and other internal departments to develop and implement vendor-related policies and group plan language.
• Escalation Management: Coordinate vendor-related questions, resolve issues, and provide status updates to client executives, client service teams, and customer service representatives.
• Process Improvement: Collaborate with internal teams to improve communication, workflows, and service delivery between members, healthcare facilities, and vendors.
• Additional Responsibilities: Perform other duties as assigned to support medical management and specialty pharmacy operations.

Requirements:

• Education: Bachelor's degree or equivalent professional work experience.
• Relevant Experience: At least five years of professional experience, including a strong understanding of pharmacy and medical benefits, specialty medications, J-codes and their administration, limited-distribution drugs, and specialty pharmacy manager selection.
• Prior Authorization Expertise: Previous experience managing pharmacy and/or medical prior authorization requests is required.
• Clinical and Medication Knowledge: Familiarity with medications used in rheumatoid arthritis (RA), transplantation, Hepatitis C, infectious diseases, and/or oncology is preferred.
• Communication Skills: Excellent written and verbal communication skills, with the ability to explain complex information clearly and coordinate effectively with members, providers, vendors, and internal teams.
• Organization and Attention to Detail: Strong organizational skills and a high level of accuracy when managing records, claims, agreements, and documentation.
• Time Management: Proven ability to meet deadlines, prioritize competing tasks, and manage responsibilities effectively in a fast-paced environment.
• Analytical and Problem-Solving Skills: Ability to evaluate information, identify issues, resolve problems, and support sound operational decisions.
• Adaptability and Initiative: Comfortable working under pressure, managing escalations, taking ownership of responsibilities, and collaborating with others to achieve results.
• Technical Proficiency: Proficiency with Microsoft Office Suite or comparable productivity software; familiarity with relevant claims or member management systems is beneficial.
• Core Competencies: Accountability, analytical thinking, collaboration, communication, customer focus, functional expertise, and initiative.
• Remote Work Requirements: Must have a reliable cable broadband or fiber-optic internet connection with minimum speeds of 100 Mbps download and 25 Mbps upload.
• Work Environment: Ability to perform standard desk-based duties involving extended periods of sitting and computer use.

Benefits:

• Annual Salary: $50,000–$55,000, depending on qualifications, experience, and the hiring process.
• Medical Insurance: Access to medical coverage options.
• Dental and Vision Coverage: Dental and vision insurance to support overall health and well-being.
• Life and Disability Insurance: Coverage options designed to provide additional financial protection.
• Paid Time Off: Generous paid time off to support rest, personal needs, and work-life balance.
• Tuition Reimbursement: Financial support for eligible educational and professional development opportunities.
• Employee Assistance Program (EAP): Resources and support for personal and professional well-being.
• Technology Stipend: Financial assistance to support technology needs for remote work.
• Remote Flexibility: Fully remote work, offering the flexibility and comfort of working from home, subject to the required reliable internet connection.