Pharmacy Services Specialist

Pharmacy Services Specialist Overview

• The Pharmacy Services Specialist coordinates pharmacy benefit management operations and supports program development and evaluation.
• Provides expertise in pharmacy needs, impacts, and projects, serving as a resource to staff and stakeholders.
• Resolves escalated customer service inquiries and grievances, ensuring quality assurance and compliance.
• Collaborates with internal teams and external partners on pharmacy coverage determinations and claim reconsiderations.
• Coordinates vendor relationships, sourcing events, and compliance activities to meet regulatory requirements.
• Develops and implements bid documents, manages performance metrics, and drives vendor engagement.
• Provides data-driven recommendations for compliance and audit issue resolution.
• Tracks vendor plans, coordinates risk assessments, and ensures vendor compliance within assigned categories.
• Facilitates vendor corrective action plans and monitors implementation for improvement initiatives.

Pharmacy Services Specialist Key Responsibilities & Duties

• Coordinate daily operations of pharmacy benefit management, ensuring effective program implementation.
• Research, develop, and evaluate programs, projects, and initiatives related to pharmacy services.
• Resolve escalated customer service inquiries and grievances, including pharmacy claim adjustments.
• Collaborate with internal stakeholders and external partners on pharmacy coverage determinations and appeals.
• Develop and implement sourcing strategies, bid documents, and vendor relationship management plans.
• Analyze market dynamics and provide optimization recommendations for sourcing results.
• Lead supplier relationship management and performance evaluations within assigned categories.
• Ensure compliance with regulatory conditions and facilitate vendor corrective action plans.
• Develop training, procedures, and recommendations for policy improvements and process changes.

Pharmacy Services Specialist Job Requirements

• Bachelor’s degree in a related field or equivalent experience required.
• Minimum of 3 years of experience in pharmacy services or related field; 5 years preferred.
• Proficiency in developing and implementing sourcing strategies and bid documents.
• Experience in vendor relationship management and performance evaluation.
• Strong analytical skills to understand market dynamics and provide optimization recommendations.
• Ability to coordinate compliance activities and ensure regulatory conditions are met.
• Excellent communication and collaboration skills for stakeholder engagement.
• Knowledge of pharmacy benefit management operations and quality assurance practices.
• Familiarity with vendor risk assessments and corrective action plan development.