This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Assist with the review activities for Commercial and Exchange coverage.

• Develop and oversee cases in collaboration with pharmacists and healthcare providers.

• Play a role in coverage determinations that impact member care and health outcomes.

• Interact with providers while managing various priorities.

• Input authorizations and process claims within the pharmacy benefit system.

• Handle both incoming and outgoing communications from providers, members, and their representatives.

• Monitor and respond to emails and FACETs inquiries related to pharmacy reviews, appeals, and claims issues.

• Examine daily pharmacy reports to verify proper claims processing.

• Support departmental audits and initiatives aimed at quality improvement.

• Be available to work evenings, holidays, weekends, and participate in on-call rotations as required to fulfill business needs.

⛳️ Requirements

• Possession of a High School Diploma or its equivalent.

• A minimum of 2 years of pharmacy experience is mandatory.

• National Certification as a Pharmacy Technician (PTCB) is required.

• Proficient in Microsoft Office applications including Outlook, Word, Excel, and PowerPoint.

• Must demonstrate teamwork abilities, strong organizational skills, and the capacity to manage multiple projects.

• Exceptional oral and written communication skills are essential.

• Strong interpersonal and organizational abilities.

• Proven skills in decision-making and problem-solving.

• Capability to work independently with minimal supervision.

• Familiarity with medical and pharmacy terminology is expected.

• Must be available to work Monday through Friday from 8 AM to 6:30 PM EST, with rotating nights and weekends.

🏝️ Benefits

• Access to tools and resources essential for success.

• Opportunities for professional growth.

• Support for creativity and continuous learning.