Job Summary

A healthcare company is seeking a Telecommute Pharmacy Operations Oversight Specialist.

Core Responsibilities of this position include:

• Assisting with appeals and grievances
• Assisting with planning, coordinating, conducting, and reporting on pharmacy operations activities
• Providing coverage determinations

Qualifications Include:

• Must have at least four years Medicare Part D/Pharmacy benefit, and/or PBM experience
• Demonstrated understanding of requirements related to Medicare Part D and/or Insurance Exchange and Commercial pharmacy products
• Experience with business analysis and continuous process improvement
• Bachelor's degree in a business related field
• Demonstrated proficiency with either SAS or SQL and Oracle/SQL including ability to write queries based on business need
• Demonstrated knowledge of Pharmacy Claim Analysis and quality practices