Pharmacy Coordinator

Pharmacy Coordinator

Company : Highmark Inc.

Job Summary : This is a call center outreach position. This job provides front line staff guidance and ensures effective and efficient delivery of pharmacy call center services. The Pharmacy Coordinator is responsible for supporting Highmark Wholecare's pharmacy programs with a focus on medication adherence and optimizing member health outcomes. This role involves a high volume of daily contacts with members, physicians, and pharmacies to address medication-related issues, promote adherence, and ensure appropriate medication utilization.

Essential Responsibilities :

• Communicate effectively with physicians and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and timely manner.
• Interact with staff to implement processes and effectively solve problems.
• Conduct outbound calls to members to discuss their medication regimens, identify barriers to adherence, and provide education and support.
• Contact physicians and pharmacists to clarify prescriptions, obtain prior authorizations, and discuss alternative therapies to improve medication adherence and reduce costs.
• Collaborate with internal teams, including pharmacists and case managers, to develop and implement strategies to improve medication adherence.
• Document all interactions and interventions accurately and completely in the appropriate systems.
• Monitor member medication adherence through claims data analysis and other available resources.
• Identify and resolve medication-related problems, such as potential drug interactions, adverse effects, and therapeutic duplications.
• Provide excellent customer service to members, physicians, and pharmacies.
• Maintain current knowledge of pharmacy practices, medications, and relevant healthcare regulations.
• Meet or exceed daily contact goals and quality standards.
• Contact physician network providers to obtain necessary and / or additional information when necessary.
• Consult clinical pharmacists for guidance and assistance as necessary.
• Identify and report improper coordination of benefit billing practices through paid claims review.
• Complete other assigned duties as specified.

Qualifications : Minimum :

Preferred :

Skills :

Scope of Responsibility :

Does this role supervise / manage other employees? No

Work Environment :

Is Travel Required? No

Disclaimer :

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement :

This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum : $19.01

Pay Range Maximum : $23.72

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@ California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID : J268962