Pharmacy Benefits Coordinator

Independent Living Systems • FL

107d

About The Position

The Pharmacy Benefits Coordinator plays a critical role in managing and optimizing pharmacy benefit programs. This position is responsible for coordinating with prescribers and targeted beneficiaries to ensure appropriate payment determination, evidence-based drug selection, and resolve medication-related problems. By maintaining accurate records and facilitating communication among stakeholders, the role helps improve patient outcomes and control pharmacy-related expenses.

Requirements

• State of Florida Registered Pharmacy Technician License (RPT) required.
• At least 2 years of experience in managed care pharmacy required.
• Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations.

Nice To Haves

• Bachelor’s degree in Health Administration, Pharmacy, Business, or a related field.
• Experience working with electronic health records (EHR) and pharmacy claims adjudication systems.
• Knowledge of Medicare, Medicaid, and commercial insurance pharmacy benefit structures.
• Familiarity with data analysis tools and reporting software.
• Bilingual in English & Spanish.

Responsibilities

• Engage in drug utilization review (DUR) by supporting letter campaigns, and telephonic outreach to members/providers.
• Maintain accurate documentation and records related to pharmacy benefits administration and communications.
• Monitor medication therapy management (MTM) services through prescriber follow-up and collaborations with other departments.
• Document and record oversight/activities in appropriate databases/software to ensure compliance with CMS and Florida Medicaid requirements.
• Consult with pharmacists and/or physicians regarding the use of medications and advise of appropriate formulary alternatives when requested.
• Respond to inquiries from other departments, physicians, and members related to formulary and prescription benefits.
• Refer all prescribers (MD, DO, APRN etc.) and customer calls related to medical questions to the Pharmacist.

What This Job Offers

• Number of Employees: 1,001-5,000 employees