Clinical Pharmacy Specialist

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

📋 Description

• Assist with Medicare and D-SNP coverage evaluation processes.

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

• Play a role in coverage decisions that impact member care and health results.

• Interface with providers while juggling various priorities.

• Input authorizations and test claims in the pharmacy benefit system.

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

• Oversee and respond to emails and FACETs inquiries related to pharmacy reviews, appeals, and claims concerns.

• Review daily pharmacy reports to guarantee proper claims processing.

• Support departmental audits and initiatives aimed at quality enhancement.

• Be available to work evenings, holidays, and weekends as necessary to maintain sufficient coverage.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• Minimum of 2 years of pharmacy experience is required.

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

• Proficient in Microsoft Office Suite (Outlook, Word, Excel, and PowerPoint).

• Must exhibit teamwork, organizational skills, and the capability to manage multiple projects.

• Exceptional verbal and written communication abilities.

• Strong interpersonal skills and organizational aptitude.

• Demonstrated decision-making and problem-solving capabilities.

• Ability to operate independently with minimal oversight.

• Familiarity with medical and pharmacy terminology.

• Availability to work Monday to Friday from 8 AM to 6 PM EST, with nights and weekends on a rotating schedule.

• Willingness to work evenings, holidays, and weekends, including on-call duties if required.

🏝️ Benefits

• Access to tools and resources essential for success.

• Opportunities for growth, creativity, and continuous learning.