Pharmacy Operations Specialist

Job Summary

Supporting pharmacy utilization management programs, the full-time remote Pharmacy Operations Specialist will process prior authorization requests, provide pharmacy-related customer service, and assist with day-to-day pharmacy operations.

Key responsibilities:

• Receive, process, and review prior authorization requests in compliance with regulatory requirements
• Apply clinical policy criteria to prior authorization reviews and communicate determinations to members and providers
• Provide pharmacy-related customer service and support new clinical program implementations

Required qualifications:

• High School diploma or equivalent required; Associate or Bachelor's degree preferred
• Two or more years of experience in a professional or pharmacy setting
• Previous experience in a managed care environment preferred
• Prior customer service experience preferred
• Strong data entry skills and attention to detail