Pharmacy Specialist
4 weeks ago
Quartz Health Solutions is seeking a highly organized and adaptable Pharmacy Specialist to join our team. In this role, you will be responsible for engaging with internal staff on drug-related benefits, with a focus on formulary management and Pharmacy and Therapeutics Committee support.
Key Responsibilities:- Perform administrative functions to support formulary management activities, including coordinating and supporting Pharmacy & Therapeutic (P&T) Committee meetings.
- Provide support and serve as a subject matter expert to internal and external stakeholders on P&T, formulary information, pharmacy care model (PCM) activities.
- Conduct detailed analysis of various data points alongside clinical pharmacists to assess medications for P&T consideration (utilization and pricing data, regulatory requirements, market assessment).
- Perform quality assurance checks on formulary documents as assigned.
- Assist in change notification processes and ongoing file maintenance to uphold accuracy and operational efficiency.
- Oversee the administration and implementation of pharmacy benefit programs, P&T Committee decisions, and benefit changes, including maintenance and updating of the formulary database, ensuring that medication lists are current and reflect the latest clinical guidelines and policy changes, and review/approval of testing by PBM and other vendors.
- Provide support in managing medication coverage requests, verifying eligibility, assessing against criteria per departmental P&Ps, ensuring required documentation is complete and accurate, and finalizing the member and provider communications.
- Resolve claim discrepancies and issues by collaborating with pharmacy benefit managers (PBMs), healthcare providers and internal teams.
- Coordinate with external vendors and partners to streamline pharmacy services and resolve operational challenges, ensuring high-quality service delivery.
- Provide training and support to internal teams on pharmacy operations, benefit programs, and compliance requirements.
- High School Diploma or equivalency is required; Bachelor's degree in a related field preferred.
- National Certified Pharmacy Technician (CPhT)
- Pharmacy Technician license in state of residence.
- 2+ years previous experience in a health care setting, managed care, PBM, or pharmacy setting is required; 5 years experience preferred.
- Prior involvement with formulary management and/or Pharmacy and Therapeutics Committees preferred.
- Knowledge of contracts, applications, products, and regulations (Medicare, ACA, Commercial).
- Knowledge of benefit systems and claims processing systems.
- Strong interest in clinical and operational pharmacy services excellence.
- Familiar with clinical program components, formulary designs, and prescription drug benefit trends.
- Able to demonstrate skills in prioritization, problem solving & critical thinking, team building, decision making, time management and strategic planning.
- Knowledge of external pharmacy related quality and performance metrics.
- Excellent organizational and interpersonal skills.
We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.
Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity, Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
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