Job Description

Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Pharmacy Services Specialist. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.Location: ** While the position is Remote, work from home, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.Contract Duration: 6+ MonthsRequired Skills & Experience

• High school diploma or GED
• 3+ years of experience in related field.
• Pharmacy Experience

What You Will Be Doing
Daily Responsibilities

• Provides daily coordination of activities related to operations of pharmacy benefit management.
• Provides support to staff and coordinates tasks regarding the research, development, implementation and evaluation of programs, projects and initiatives.
• Serves as resource to staff and subject matter expert for assigned initiatives to provide input regarding pharmacy needs, impacts and projects.
• Resolves issues and escalates to management as appropriate; assists management in addressing clinical and contractual issues.
• Coordinates review, implementation, and quality assurance of benefit plan administration with internal stakeholders and PBM account team.
• Resolves or coordinates the resolution of escalated customer service inquiries and grievances internally and with PBM, including researching and authorizing/making pharmacy claim adjustments as appropriate.
• Coordinates the resolution of Pharmacy Coverage Determinations with Clinical Staff and/or external partners as appropriate
• Coordinates the resolution of pharmacy claim reconsiderations and appeals with the Appeals department and/or external partners as appropriate.
• Responsible for responding to and coordinating review and approval of RFPs, government program applications, and similar requests.

****To be eligible to contract at this client you must be able to pass a drug test and criminal background check

Motion Recruitment