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Pharmacy Specialist II
Pharmacy Specialist II
Greensboro, NC • Pharmacy Operation
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.
High School Diploma or GED
Registered Pharmacy Technician or at least 3 years working for a Pharmacy Benefit Manager or in a Health Plan setting. Licensed Pharmacy Technician (CPhT)
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
Proficient in Word, Excel, and PowerPoint
Ability to work independently.
Experience reviewing Pharmacy claims data
Experience working with regulatory agencies and in a compliance environment
Time: Full time
Updated: 12/22/2020 3:12:31 PM