Pharmacy Benefit Coordinator
About The Position
The Pharmacy Benefit Coordinator is responsible for supporting clinical outreach services to our members, their pharmacies, and their healthcare providers to ensure member safety, minimize gaps in care, identify cost-effective medication strategies, and coordinate care to improve healthcare outcomes for our members. The position will support HEDIS adherence initiatives and work to support longitudinal improvement goals. In addition, the Pharmacy Benefit Coordinator performs a variety of routine to moderately complex administrative and pharmacy-related tasks that support the Pharmacy Management team within the department. The Pharmacy Management team is responsible for managing the pharmacy benefits for Maryland Physicians Care in collaboration with the pharmacy benefit management (PBM) vendor and the organization’s utilization review, quality improvement, provider relations, and population health initiatives. About Maryland Care Management, Inc. (MCMI) Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.
Requirements
- Thorough understanding of prescription benefit management (PBM) programs and practices.
- Ability to identify, communicate findings, and resolve member, provider, process, and system issues, communicating recommendations verbally and in writing.
- Business writing and presentation skills, including writing reports.
- Excellent attention to detail, including but not limited to interpretation and understanding of benefits/codes.
- Familiarity with government relations and the ability to operationalize and understand how various aspects of regulation are interdependent and related.
- High School diploma/ GED, or equivalent.
- Current Maryland State Pharmacy Technician licensure, including certification from a nationally recognized Pharmacy Technician Certification Board.
- Minimum two (2) years of experience as a pharmacy technician.
- Experience working in a managed care, insurance, PBM, or equivalent environment is strongly preferred.
- Experience supporting utilization management/prior authorization processes.
Responsibilities
- Work collaboratively with quality management to support HEDIS adherence projects.
- Support the accurate implementation and coding of pharmacy benefits, formulary, and program changes, including review of PBM testing scenarios.
- Review pharmacy services recommended for denial. Of those recommendations, investigate and review data and information retrieved from plan providers.
- Assist in the management of members by collecting pertinent information from plan providers and other pharmacy data systems.
- Assist in various pharmacy, utilization review/management, quality improvement, provider relations, and population health initiatives.
- Serve as a pharmacy liaison and resource person to plan pharmacies and members.
- Assist the Pharmacist with monitoring and evaluation of pharmacy utilization.
Benefits
- medical, dental, and vision plans
- 100% employer Term Life Insurance
- Short and Long-Term Disability
- 401k Employer Match up to 4%
- 20 days of PTO
- tuition assistance/professional development plans
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
