Pharmacy Operations Coordinator

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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American Health Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1976

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

American Health Partners is a healthcare organization focused on improving access to and coordination of high-quality care through a continuum of services tailored to institutional and special-needs populations. The company operates institutional special needs health plans and provides specialized care coordination, geriatric inpatient and acute psychiatric care, and pharmacy services for long-term-care facilities, supported by an owned/affiliated network of locations and thousands of contracted providers. American Health Partners emphasizes convenient, preventive care to reduce costly hospital stays and improve patient outcomes and quality of life.

📋 Description

• Serve as primary contact between the Plan and pharmacy benefit manager (PBM) • Perform PBM oversight and monitoring • Report and escalate performance deficiencies and status to management and the compliance department • Review, conduct outreach, and track rejected pharmacy claims involving non-formulary, prior authorization (PA), Step Therapy (ST), and Quantity Limit (QL) requirements • Ensure regulatory requirements are met for coverage determinations and redeterminations • Lead annual readiness activities • Liaise with the Enrollment Department to ensure appropriate member eligibility processing • Support CMS Plan reporting, audits, monitoring activities, and submissions • Assist with and track incoming calls from agents, pharmacies, nursing homes, providers/nurses, and members • Coordinate monthly website updates • Monitor and report departmental metrics • Work on special projects and business initiatives as assigned • Perform other duties as assigned

🎯 Requirements

• High school diploma or equivalent required • Pharmacy technician qualification/license/certification required • Experience in the pharmacy department of a Medicare Advantage or Part D plan preferred • Maintain regular and reliable attendance • Attention to detail • Ability to work in a high-demand, fast-paced environment • Experience in planning and implementation • Strong analytical skills • Strong leadership and collaboration skills • Extensive knowledge of Medicare compliance • Customer and quality focus • Follow up and resolve open items in a timely manner • Adhere to all compliance requirements and CMS regulations • Successfully complete required training • Handle multiple priorities effectively • Exercise independent discretion and decision-making • Make decisions under pressure