Pharmacy Coordinator (Appeals) - Remote

Overview

The Pharmacy Coordinator (Appeals) plays a crucial role in supporting the pharmacy department's efforts in managing the health plan's pharmacy program, focusing on appeals and prior authorizations.

In Short

• Support the pharmacy department in coordinating and maintaining the pharmacy program.
• Handle provider and pharmacy calls regarding prior authorization and formulary processes.
• Review pharmacy overrides in compliance with guidelines.
• Track and audit prior authorizations and overrides.
• Resolve complaints related to the pharmacy network.
• Educate providers on the pharmacy process.
• Assist with pharmacy utilization review and reporting.
• Collaborate with the Quality Improvement department.
• Manage inquiries related to the formulary process.
• Comply with all policies and standards.

Requirements

• High school diploma or equivalent.
• 3+ years of pharmacy experience, preferably in managed care.
• Medicare and/or Medicaid experience preferred.
• Experience with analysis tools or systems.
• Experience in quality process improvement efforts.
• Ability to document requirements and create training materials.
• Current state's Pharmacy Technician license preferred.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules.