Base: $30 ph; bonus/equity: not specified; benefit...
Fully remote
Active pharmacy technician license required
Three years experience in health plan or pbm
Prior authorization for medicare part b and d
The Clinical Pharmacy Specialist will perform duties across all lines of business including Utilization Management, Formulary Support, Appeals and Grievances, and Audit and Reporting Support
Job Summary
The Clinical Pharmacy Specialist will perform duties across all lines of business including Utilization Management, Formulary Support, Appeals and Grievances, and Audit and Reporting Support.
This role requires reviewing coverage for medications under pharmacy and medical benefits for Medicare Part B, Part D, and Commercial Plans while communicating criteria to physicians and providers.
The position involves supervising support services, maintaining policies and procedures, and ensuring compliance with regulatory standards such as HIPAA and Medicare Advantage requirements.
Matching Summary
The Clinical Pharmacy Specialist will perform duties across all lines of business including Utilization Management, Formulary Support, Appeals and Grievances, and Audit and Reporting Support.
Salary
Base: $30 per hour; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
Active Pharmacy Technician License required
Three years experience in health plan or PBM
Prior authorization for Medicare Part B and D
Knowledge of J/Q codes ICD-10 CMS 1500
Proficiency in pharmacy computerized systems
Nice-to-have
Bilingual in English and Spanish preferred
Ability to identify and troubleshoot issues independently
Experience with Fraud Waste and Abuse programs
Strong written and verbal communication skills
Adaptability to changing workload and responsibilities
Key Requirements
Active Pharmacy Technician License
Minimum three years experience in health plan or PBM
Basic knowledge of medical terminology and coding (J/Q codes, ICD-10)
Proficiency in MS Office Product Suite and pharmacy software