[Hiring] Gaps in Care Pharmacy Coordinator @Capital Blue Cross

Role Description

The Pharmacy Coordinator position is responsible for the coordination and the integrity of the Commercial and Medicare Part D prescription drug benefit plan level (BPL) administration and servicing activities associated with the pharmacy program. The position serves as a day-to-day contact with the pharmacy benefits manager (PBM) for issue resolution and program implementation. This position provides operational support for the Pharmacy Department.

• Provide department operational support, including but not limited to:
  • Benefit plan designs set-ups
  • Requests for Proposal (RFP) or Request for Information (RFI) responses
  • Database maintenance
  • Report production
  • Benefit/program training and presentations
  • Sales guideline maintenance
  • Member/group educational materials development/maintenance/inventory
  • Provider manual update
• Troubleshoot or translate operational needs into a comprehensive action plan and take the lead in its execution.
• Identify, plan, develop, implement, and monitor performance of new pharmacy benefits and programs to maximize market position.
• Handle benefit, group/member, or operational issues using interpersonal and team skills.
• Track and document issues/projects to ensure timely and complete resolution/deployment.
• Manage assigned projects with detailed project plans and methodologies, effective work teams, and creative/innovative solutions, which meet or exceed established project objectives.
• Assist to identify operational and service problems, recommend and implement process enhancements and efficiencies leading to improved departmental productivity.
• Comprehension of State and Federal Laws/Regulations relating to the administration of Rx Drug Benefits.
• Serve as a liaison between the pharmacy vendor(s) and various internal departments to coordinate immediate benefit or coverage needs of members as well as to prioritize and direct the pharmacy steering work group activities.
• Handle escalated or complex customer inquiries and complaints concerning the prescription benefit in a timely, objective, and accurate manner.
• Apply clinical criteria and analytical experience to perform prior authorization reviews.

Qualifications

• Proficient research and analytical skills.
• Strong organizational skills to manage day-to-day activities, coordinate multiple tasks, monitor and document issues/projects to ensure timely and complete resolution, and manage time effectively.
• Strong communication skills; effectively communicate (verbally and in writing) with all levels of plan personnel and external contacts with professionalism (courtesy, persuasion, and tact).
• Strong interpersonal and team skills with ability to work and interact externally and internally to handle benefit, group/member, or operational issues.
• Ability to meet stringent deadlines and handle rapidly changing priorities with minimal supervision.
• Ability to track and document issues/projects to ensure timely and complete resolution/deployment.
• Strong project management skills to manage assigned projects with detailed project plans and methodologies, effective work teams, and creative/innovative solutions, which meet or exceed established project objectives.
• Ability to troubleshoot or translate operational needs into a comprehensive action plan and take the lead in its execution.
• Ability to take direction from and perform project work for various levels of staff.
• Ability to operate a PC and applications, such as Word, Excel, PowerPoint, Access and other Pharmacy reporting software.

Requirements

• Knowledge and experience in the pharmacy industry, pharmacy benefit manager, and understanding prescription claims processing.
• Comprehension of State and Federal Laws/Regulations relating to the administration of Rx Drug Benefits.
• 3 years relevant experience.
• Experience with drug utilization review (DUR) and prior authorization review.
• Experience with presentation in a variety of audiences and settings.

Education and Certifications

• Must have high school diploma or GED.
• Prefer a Bachelor’s degree in Business Administration, Healthcare Administration in a health science field or previous work experience with pharmacy benefit administration or in the PBM industry.
• Preference will be given to candidates with relevant pharmacy-related training, certification, or degree.

Physical Demands

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.