Pharmacy Coordinator – FWA

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Evaluate and address fraud, waste, and abuse (FWA) referrals, inquiries, and requests from both internal and external stakeholders.

• Assist with regulatory requests, documentation, and reporting associated with FWA investigations and reviews.

• Investigate and help resolve issues related to inappropriate billing, waste, and potential FWA activities.

• Engage with members, providers, and pharmacies to collect information and support initial reviews.

• Create and analyze reports to identify trends, aid investigations, and support program oversight.

• Contribute to improvements in departmental processes and ensure accurate documentation is maintained.

• Assist the pharmacy department in the development, coordination, and maintenance of the health plan's pharmacy program.

• Handle provider and pharmacy inquiries concerning pharmacy benefits.

• Address complaints and grievances related to the pharmacy network in collaboration with the Pharmacy team.

• Support departments in educating providers about the health plan’s pharmacy procedures.

• Aid in the pharmacy utilization review and reporting process.

• Assist with inquiries from members.

• Perform additional assigned duties and activities as needed.

• Adhere to all established policies and standards.

⛳️ Requirements

• A minimum of 3 years of experience as a pharmacy technician, preferably within a managed care setting.

• Background in a dispensing pharmacy environment, including retail, specialty, long-term care, or mail-order pharmacy.

• Preferred experience with Medicare and/or Medicaid.

• Strong attention to detail along with analytical thinking and organizational capabilities.

• Ability to work collaboratively in a team-oriented setting while managing multiple priorities effectively.

• Proficiency in Microsoft Office applications, such as Word, Excel, PowerPoint, and Outlook.

• Exceptional verbal and written communication skills with members, providers, pharmacies, and internal stakeholders.

• Interest in fraud, waste, and abuse prevention, as well as compliance and program integrity.

• High school diploma or equivalent is required.

• Previous experience using analytical tools or systems.

• Experience in implementing quality process improvement initiatives.

• Familiarity with documenting requirements, creating training materials, and working directly with end users.

• Current pharmacy technician license from the state is preferred.

• Availability Monday through Friday, 8:00 AM to 4:30 PM Eastern or Central time.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plans.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Potential for incentives as part of total compensation.