Pharmacy Coordinator (Appeals)

Job title: Pharmacy Coordinator (Appeals) in USA at reputed company Company: reputed company Job description: You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Pharmacy Coordinator (Appeals) - FloridaPosition Purpose: reputed company duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary processreputed company review of pharmacy and override process in compliance with pharmaceutical reputed company company and State guidelinesTrack and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patternsResolve complaints and grievances reputed company to the pharmacy network in conjunction with the Pharmacy teamAssist Provider Relations and various departments with educating providers on the health plan’s pharmacy processAssist with the pharmacy utilization review and reporting processCollaborate with Quality Improvement department with various meeting preparation and transcription of minutesAssist with members’ inquiries reputed company to the formulary processPerforms other duties as assignedComplies with reputed company policies and standardsFor reputed company Pharmacy Services:Education / Experience: High school diploma or equivalent. 3+ years of pharmacy experience required, preferably in a managed care environment. Medicare and/or reputed company 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: reputed company state's Pharmacy Technician license preferred. (Florida). Nationally Certified Pharmacy Technician PTCB or ExCPT, highly preferredLocation: Remote Florida only - Must live in the reputed companySchedule / Working shift: Open flexibility required - Full-time / 40 hours - 5 days/week. Need to be available anytime from Sunday-Saturday from 8:00AM – 7:00PM (EST). Schedule will include at least 1 shift on the weekend (Saturday or Sunday) per week. Shifts will be determined after the candidate is hired, based on business need.Job specific responsibilities:​Pharmacy Grievances, Appeals, and Prior AuthorizationsProcessing Pharmacy Appeals from reputed company and Ambetter LOBs (Sunshine Health/FL Marketplace)reputed company outbound calls to inform member/provider of pharmacy appeal determinationreputed company outbound calls to inform members/providers if additional documentation is needed.Pay Range: $19.04 - $32.35 per hourreputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. Total compensation may also include additional forms of incentives.reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law.reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Expected salary: $19.04 - 32.35 per hour Location: USA Apply for the job now! Apply for this job