Pharmacy Coordinator-CW

The Pharmacy Coordinator provides frontline staff guidance and ensures effective and efficient delivery of Pharmacy call center services. Serves as first-line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable, and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point-of-sale prescription claim transitions and coordination of benefits practices/procedures.

Required :
High School Diploma/GED Required
Pharmacy Experience Required
Pharmaceutical Knowledge
3-5 yrs of Customer Service Required
Proficient in Microsoft Suite
Barrier Identification & Problem Solving

Preferred:
1-3 years of Healthcare Insurance Experience Strongly Preferred
Pharmacy Benefits Management Understanding
Bilingual (Spanish)