Pharmacy Coordinator 1

Position Title : Pharmacy Coordinator 1

Work Location : Remote - Nationally sourced

Assignment Duration : 6 months

Work Schedule : Monday - Friday (8 AM to 4 : 30 PM). No overtime and flexible start / end time.

Work Arrangement : Remote

Position Summary :

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

Background & Context :

The team's purpose is responsible for building and maintaining decision tools, also known as questionnaires. These tools support pharmacy operations, specifically around prior authorization processes. We develop and manage configurable questionnaires that align with health plan and drug policies which help the prior authorization reviewers make their determination.

We are a collaborative and supportive team that values clear communication, accountability, and continuous improvement. This team works cross-functionally with other pharmacy operational teams. We're part of a large pharmacy department that is focused on optimizing workflows and improving patient outcomes through smarter, more efficient tools.

Key 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
• Create DT loaders in Excel that will be uploaded to MHK / Compass platform
• Configure decision tools into the MHK / Compass platform
• Conduct testing to ensure decision tools are proper functioning
• Update decision tools to align with integration of Express Scripts
• Follow training instructions and complete training sessions in a timely manner
• Maintain high-quality level work
• Pay close attention to details
• Complete monthly configuration on time

Qualification & Experience :