Pharmacy Coordinator 1

Position Summary:

Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Background & Context:

Execute targeted quality improvement efforts to strengthen Medicare Pharmacy STAR measure performance and achieve year-end goals. Surrounding Team: Diverse, collaborative, and supportive environment. No additional upcoming hiring needs.

Key Responsibilities:

* Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process

* Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines

* Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns

* Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team

* Assist Provider Relations and various departments with educating providers on the health plan's pharmacy process

* Assist with the pharmacy utilization review and reporting process

* Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes

* Assist with members' inquiries related to the formulary process

* Performs other duties as assigned

* Complies with all policies and standards