Pharmacy Coordinator 1 - 210120

Description: Job Profile Summary

Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.

For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.

For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.

For *** Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.

Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process

Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines

Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns

Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team

Assist Provider Relations and various departments with educating providers on the health plan s pharmacy process

Assist with the pharmacy utilization review and reporting process

Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes

Assist with members inquiries related to the formulary process
Performs other duties as assigned

Complies with all policies and standards

Custom Fields:
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: None

Name: Which Health Plan, programs or functions will this work support?
Value: WellCare of KY

Name: Shortlisting Date
Value: None

Name: Field Worker
Value: No