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Pharmacy Specialist

Job Summary

The Pharmacy Specialist is responsible in assisting the Pharmacy Program Manager with the execution of the Part D pharmacy operations (e.g. reporting, coverage determinations, B vs. D reviews, formulary administration, Medication Therapy Management, etc.). This position will also interact with the pharmacy benefit manager to perform compliance reviews (e.g. appeals and grievances, claims, etc.), maintain quality metrics, and help implement strategies to achieve desired quality and STAR measures.

Qualifications
Required Education

High School Diploma or GED
Licensure/Certification Regulatory

Licensed Pharmacy Technician(CPhT)

Required Experience
One (1) or more years of Medicare Part D experience
Proficient in Word, Excel and PowerPoint

Preferred Experience
Experience working with regulatory agencies and in a compliance environment
Experience interacting with other healthcare professional and proficiency in medical and pharmacy terminology

Major Work Activities (MWA’s)
Support managing the plan formulary in collaboration with the pharmacist and the pharmacy benefits management (PBM) company
Supporting the Medicare Part D Appeals and Grievances tracking programs through appropriate identification, intake into the internal tracking log and outreach to providers, pharmacies and members to resolve the appeal or grievance; formulate written responses to member concerns and complaints
Collaborate with the operations and compliance teams to perform auditing and monitoring of Pharmacy Benefits Manager (PBM) activities and performs other related duties and special projects as assigned
Review and resolve rejected pharmacy claims
Support and participate in improving member medication adherence and related programs to improve health outcomes; support extracting and analyzing data to identify trends or areas of concern

KNOWLEDGE, SKILLS AND ABILITIES
Knowledge of applicable Medicare Advantage
Strong in the following competencies:
Decision making/Judgment
Problem solving/Analysis
Communication
Creativity/Innovation
Ability to work independently
PHYSICAL REQUIREMENTS

Sedentary Work
Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or;
A negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

HEARING / VISION
Hear and differentiate low volume sounds in order to make judgments regarding actions needed
Hear alarm bells, verbal conversations, telephone voices and normal volume sounds
Close vision (clear vision at 20 inches or less)
Distance vision (clear vision at 20 feet or more)
Depth perception (three-dimensional vision, ability to judge distances and spatial relationships)
Color vision (ability to identify and distinguish color)

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 10/16/2018 2:02:48 PM