Pharmacist Program Coordinator - Medical Benefit & Specialty

Pharmacist Program Coord - Medical Benefit & Specialty

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Summary :

Responsible for medical benefit and specialty drug management and interventions. Responsible for first line utilization management reviews and maintaining / updating clinical criteria for drugs covered under the medical benefit. Management of the site of care and white bagging programs, develop new strategies and engage providers and / or members to conduct clinically and financially meaningful interventions that impact member drug therapy. These interventions are aimed at improving pharmaceutical care for our members and reducing total cost of drug therapy.

1. Formal Education Required :

a. Pharm. D. or Bachelor degree in pharmacy from an accredited College or School of Pharmacy. Must be a licensed pharmacist within the United States.

2. Experience & Training Required :

a. Three (3) years experience working in a managed healthcare or home infusion environment, with working knowledge of clinical utilization management guidelines and medical benefit and specialty drugs, include two (2) years working knowledge of Medicare.

Essential Functions :

1) Perform first line medical drug utilization management clinical reviews, in coordination with Medical Directors, for all lines of business. Review, revise and create medical benefit drug criteria as needed. Serve as back up to perform pharmacy benefit appeals.

2) Manage SummaCare site of care and white bagging program and policy. Work with providers, members and vendors to find and coordinate the most appropriate and cost effective site of care.

3) Develop new strategies and engage providers and / or members to conduct clinically and financially meaningful interventions that impact member drug therapy.

4) Manage relationship with Medical Drug Benefit vendor, oversight medical drug rebate and biosimilar programs.

5) Participates in High Cost Pharmacy meetings and track progress and overall savings from programs and initiatives.

6) Responsible for maintaining medical drug benefit codes, review new medical drug benefit codes and submit updates to existing codes to configuration.

3. Other Skills, Competencies and Qualifications :

a. Read, Analyze and interpret primary medical literature, government regulations, CMS memos, general business periodicals, professional journals, technical procedures, standards and specifications.

b. Apply principles of logical thinking to define problems, collect data, establish facts, draw valid conclusions and prepare recommendations

c. Efficient in Microsoft Word, Excel, Outlook, and PowerPoint.

d. Effective interface with all staff levels

e. Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment.

f. Maintain current knowledge of and comply with regulatory and company policies and procedures.

g. Maintain confidentiality of member health and business information.

h. Ability to adjust work hours to meet business demands.

i. Ability to effectively interact with populations of patients / customers with an understanding of their needs for self-respect and dignity

4. Level of Physical Demands :

a. Be able to sit and / or stand for prolonged periods of time

b. Manual dexterity to operate computer, phone and standard office machines

Equal Opportunity Employer / Veterans / Disabled

$60.24 / hr - $90.35 / hr

The salary range on this job posting / advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

• Basic Life and Accidental Death & Dismemberment (AD&D)
• Supplemental Life and AD&D
• Dependent Life Insurance
• Short-Term and Long-Term Disability
• Accident Insurance, Hospital Indemnity, and Critical Illness
• Retirement Savings Plan
• Flexible Spending Accounts – Healthcare and Dependent Care
• Employee Assistance Program (EAP)
• Identity Theft Protection
• Pet Insurance
• Education Assistance
• Daily Pay