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Pharmacy Operations Specialist
2 months ago
Remote Opportunity for Pharmacy Operations Specialist
Join our dynamic team as a Pharmacy Operations Specialist, where your primary responsibility will be to manage and assess coverage determination requests from healthcare providers, identifying when a pharmacist's evaluation is necessary. In this role, you will engage in obtaining verbal authorizations, soliciting comprehensive clinical details from prescribers, and approving coverage requests based on established guidelines.
Your duties will include accurately entering and documenting decisions within the Pharmacy Benefit Manager (PBM) system and communicating outcomes to providers and/or members. You will also address client inquiries related to authorization approvals and PBM online platforms, refer specialty drug requests to the appropriate vendor or client, and reach out to providers for additional information to support reviews.
Key Responsibilities:
- Track and triage coverage determination requests.
- Obtain verbal authorizations and detailed clinical information.
- Document decisions in the PBM system.
- Notify stakeholders of decisions promptly.
- Assist clients with inquiries regarding authorizations.
Required Skills:
- Experience in retail, hospital, or mail order pharmacy settings.
- Proficiency in utilizing PBM systems.
- Valid state Pharmacy Technician license.
- National Certification from the Pharmacy Technician Certification Board (CPhT).
Preferred Attributes:
- Effective triage and task prioritization abilities.
- Excellent communication skills for interactions with prescribers and clients.
- Detail-oriented with a strong emphasis on accuracy.
This position is fully remote, allowing you to work from the comfort of your home.
About Actalent: Actalent is a global leader in engineering and sciences services and talent solutions. We empower innovative companies to advance their engineering and science initiatives by providing access to specialized experts who drive scale, innovation, and speed to market.
With a vast network of nearly 30,000 consultants and over 4,500 clients across the U.S., Canada, Asia, and Europe, Actalent collaborates with many Fortune 500 companies.
Diversity, Equity & Inclusion: At Actalent, we believe that diversity and inclusion are essential to the equity and success of our workforce. We are committed to:
- Hiring diverse talent.
- Maintaining an inclusive environment through ongoing self-reflection.
- Building a culture of care, engagement, and recognition with clear outcomes.
- Ensuring growth opportunities for all employees.
Actalent is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.
