Search Page | Back to Results

Pharmacy Specialist II

Pharmacy Specialist II
Greensboro, NC • Pharmacy Operation
Description
Job Summary

The Pharmacy Specialist II is responsible for assisting the Director of Pharmacy 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 benefits manager to perform compliance reviews (e.g. appeals and grievances, claims, etc.). maintain quality metrics, and help implement strategies to achieve desired quality STAR measures. In addition, this position will also coordinate with the Utilization Management and Care Management teams to work with members requiring medication assistance. The position will also work with the Clinical Pharmacist and Quality/STARs team to perform member outreach for individuals identified in STAR measures such as Medication Adherence and Statin Use.

Major Work Activities

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
Coordinate, gather and perform outreach necessary to assist members requiring medication assistance.
Coordinate member medication adherence and related programs to improve health outcomes; support extracting, analyzing data, and proactive outreach to members identified with open gaps.
Other duties as assigned.
Requirements
Requirments

Minimum Qualifications

Required Education

High School Diploma or GED

Licensure/Certification

Registered Pharmacy Technician or at least 3 years working for a Pharmacy Benefit Manager or in a Health Plan setting. Licensed Pharmacy Technician (CPhT)

Experience

One (1) or more years of industry experience, preferably in healthcare, pharmacy, insurance, or PBM industry

Experience interacting with other healthcare professionals, and proficiency in medical and pharmacy terminology

Knowledge, Skills, and Abilities

Knowledge of applicable Medicare and Part D regulations

Strong in the following competencies

Decision making/judgment
Problem-solving/Analysis
Communication
Creativity/Innovation
Proficient in Word, Excel, and PowerPoint
Ability to work independently.

Preferred Qualifications

Experience

Experience reviewing Pharmacy claims data

Experience working with regulatory agencies and in a compliance environment

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

Updated: 12/22/2020 3:12:31 PM