Senior Pharmacy Professional
New
Based in United StatesFull-TimeSenior
SalaryCompetitive annual salary ranging from $71,100 to $97,800 depending on experience and qualifications.
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Job Details
- Experience
- 2+ years of experience in pharmacy benefits management, pharmacy claims, or related healthcare operations.
- Required Skills
- Data AnalysisMicrosoft OfficeCompliance
Requirements
- Bachelor’s degree in pharmacy, healthcare administration, or related field.
- 2+ years of experience in pharmacy benefits management, pharmacy claims, or related healthcare operations.
- Strong analytical and problem-solving skills with experience in data-driven workflow or process improvement initiatives.
- Proficiency in MS Office tools including Excel, Word, PowerPoint, and Visio.
- Experience working within Medicaid, Medicare, or similar healthcare programs is highly preferred.
- Ability to interpret pharmacy utilization data and translate insights into actionable recommendations.
- Strong communication and collaboration skills with the ability to work across clinical, operational, and administrative teams.
- Experience participating in audits, compliance activities, or regulatory reporting is a plus.
Responsibilities
- Serve as the primary pharmacy subject matter expert supporting Medicaid and FIDE SNP programs, resolving complex pharmacy claims and member issues.
- Intake, investigate, and independently resolve pharmacy-related inquiries from care management teams, ensuring timely and accurate solutions.
- Lead pharmacy governance and coordination efforts, including facilitating steering committee meetings with internal and external stakeholders.
- Analyze pharmacy utilization data to identify trends, inefficiencies, and opportunities for process improvement and better member outcomes.
- Support audits, compliance reviews, and regulatory requirements at state and federal levels, ensuring adherence to applicable standards.
- Collaborate with pharmacy benefit managers, care management, and quality improvement teams to optimize workflows and member interventions.
- Develop pharmacy-related policies, training materials, and job aids to support operational consistency and knowledge sharing.
- Participate in transition and integration activities with pharmacy vendors, including data reconciliation and file transfers.
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