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

📋 Description

• Assist with the review activities related to Commercial and Exchange coverage.

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

• Play a role in coverage determinations and appeal processes.

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

• Manage incoming and outgoing communications with providers, members, and member representatives.

• Monitor and respond to emails and FACETs inquiries concerning pharmacy reviews, appeals, and claims matters.

• Analyze daily pharmacy reports to ensure claims are processed appropriately.

• Support departmental audits and participate in quality improvement initiatives.

• Be available to work evenings, holidays, weekends, and rotating on-call shifts as required to fulfill business needs.

⛳️ Requirements

• High School Diploma or equivalent is mandatory.

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

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

• Proficiency in Microsoft Office Suite (Outlook, Word, Excel, and PowerPoint) is necessary.

• Must demonstrate teamwork, organizational skills, and the ability to manage multiple projects efficiently.

• Outstanding oral and written communication abilities are required.

• Strong interpersonal and organizational skills are essential.

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

• Ability to work independently with minimal supervision is required.

• Familiarity with medical and pharmacy terminology is preferred.

• Candidates with MHK experience are highly preferred.

• Availability from Monday to Friday, 8 AM to 6:30 PM EST, with flexibility for nights and weekends on a rotating basis is required.

• Capability to work remotely and manage complex information in a remote setting is essential.

🏝️ Benefits

• Flexible remote work arrangement.

• Support for growth, creativity, and continuous learning.

• Access to tools and resources necessary for success.

• Employee status benefits.

• Opportunities for rotating on-call shifts, which may include evenings, holidays, and weekends.