Pharmacy Services Specialist

Pharmacy Services Specialist Overview

• The Pharmacy Services Specialist role focuses on supporting pharmacy benefit management operations and ensuring seamless coordination of related activities.
• Provide expertise in pharmacy needs, impacts, and projects, serving as a resource for staff and stakeholders.
• Coordinate research, development, implementation, and evaluation of programs, projects, and initiatives in pharmacy services.
• Address escalated customer service inquiries and grievances, ensuring timely resolution and quality assurance.
• Collaborate with internal stakeholders and external partners to manage pharmacy coverage determinations and appeals.
• Support the review and approval process for RFPs, government applications, and similar requests.
• Assist management in addressing clinical and contractual issues, providing valuable input and recommendations.
• Contribute to the quality assurance of benefit plan administration and pharmacy claim adjustments.

Pharmacy Services Specialist Key Responsibilities & Duties

• Coordinate daily operations related to pharmacy benefit management, ensuring efficient task execution.
• Research, develop, implement, and evaluate pharmacy-related programs and initiatives.
• Resolve escalated customer service inquiries and grievances, collaborating with internal and external teams.
• Manage pharmacy coverage determinations and appeals, ensuring compliance and accuracy.
• Provide input and expertise on pharmacy needs, impacts, and projects to support organizational goals.
• Coordinate the review and approval of RFPs and government program applications.
• Assist in addressing clinical and contractual issues, escalating matters to management when necessary.
• Ensure quality assurance in benefit plan administration and pharmacy claim adjustments.

Pharmacy Services Specialist Job Requirements

• Bachelor of Arts (BA) degree or equivalent educational background required.
• Minimum of 3 years of experience in a related field, with 5 years preferred.
• Strong knowledge of pharmacy benefit management operations and related processes.
• Proficiency in coordinating pharmacy coverage determinations and appeals with internal and external stakeholders.
• Ability to address escalated inquiries and grievances, ensuring timely and effective resolution.
• Experience in reviewing and approving RFPs and government program applications.
• Excellent communication and coordination skills to manage diverse pharmacy-related tasks.
• Familiarity with clinical and contractual issues in pharmacy services.