Pharmacy Coordinator – Remote

About the role

The Pharmacy Coordinator works remotely to guide front‑line staff and ensure the efficient delivery of pharmacy call‑center services. This role acts as the first line reviewer for health‑plan drug benefit designs and handles inquiries from physicians and pharmacy network providers.

Key responsibilities

• Provide guidance to front‑line staff and oversee pharmacy call‑center operations.
• Monitor compliance with state and federal drug benefit designs.
• Respond to physician and pharmacy network inquiries about oral, injectable, and infusion medication requests, claim edits, and prior authorizations.
• Review member claims history to determine medical necessity for non‑formulary and prior‑authorization medication exceptions.
• Interact with pharmacy network providers to evaluate, educate, and assist with denied point‑of‑sale prescription claims and coordination‑of‑benefits processes.

Required profile

• High School Diploma or GED.
• 3–5 years of customer service experience.
• Pharmacy experience with solid pharmaceutical knowledge.
• Understanding of Pharmacy Benefits Management.
• Ability to identify barriers and solve problems.
• Proficiency in Microsoft Suite.

Required skills

• Microsoft Suite