Pharmacy Quality Specialist

Pharmacy Quality Specialist Overview

• The Pharmacy Quality Specialist oversees pharmacy benefit management operations, ensuring quality and compliance with established standards.
• Provides support in research, development, implementation, and evaluation of pharmacy-related programs and initiatives.
• Acts as a subject matter expert, offering guidance on pharmacy needs, impacts, and projects.
• Coordinates benefit plan administration reviews and quality assurance with internal teams and external partners.
• Resolves escalated customer service inquiries and grievances, ensuring timely and effective solutions.
• Handles pharmacy claim adjustments and collaborates with clinical staff for coverage determinations.
• Supports management in addressing clinical and contractual issues, providing valuable insights and recommendations.
• Responds to RFPs, government program applications, and similar requests, ensuring compliance and accuracy.

Pharmacy Quality Specialist Key Responsibilities & Duties

• Coordinate daily operations related to pharmacy benefit management, maintaining efficiency and compliance.
• Provide support in research, development, and evaluation of pharmacy-related programs and initiatives.
• Serve as a resource and subject matter expert for pharmacy projects and initiatives.
• Resolve escalated customer service inquiries and grievances, ensuring satisfactory resolutions.
• Coordinate benefit plan administration reviews with internal stakeholders and external partners.
• Collaborate with clinical staff and external partners for pharmacy coverage determinations.
• Handle pharmacy claim reconsiderations and appeals, ensuring accurate and timely resolutions.
• Assist management in addressing clinical and contractual issues, providing insights and solutions.

Pharmacy Quality Specialist Job Requirements

• High school diploma or GED required; additional certifications in pharmacy-related fields preferred.
• Minimum of 3 years of experience in pharmacy or related field; 5 years preferred.
• Strong knowledge of pharmacy benefit management and related operations.
• Proficiency in resolving customer service inquiries and grievances effectively.
• Experience in coordinating benefit plan administration and quality assurance processes.
• Ability to collaborate with clinical staff and external partners on pharmacy-related matters.
• Familiarity with responding to RFPs and government program applications.
• Excellent communication and organizational skills to manage multiple tasks effectively.