Pharmacy Coordinator II, Medicare

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Reporting to the Manager of Medicare Pharmacy Services, the Pharmacy Coordinator II, is primarily responsible for supporting the activities of the Plan's Part D formulary management, compliance, reporting and oversight functions as directed by and in collaboration with other Medicare Part D related operations. In addition the Pharmacy Coordinator will support the day-to-day operations of the pharmacy utilization management program, processing any escalated PBM issues and coordinating coverage decisions and appeals as needed. As well as supporting the activities of the Pharmacy Department's STARS Quality program.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.
• Coordinates daily activities such as review and resolution of claims reject reports and transition monitoring.
• Drafts and sends provider communications as needed to ensure member access to medication.
• Develops and maintains expert knowledge on all CMS regulations as they pertain to this position.
• Liaisons with other internal and BMC departments such as appeals and grievances, members services and care management as appropriate in order to provide necessary information and service in a timely and complete manner. Educates other departments regarding Pharmacy processes as necessary.
• Coordinate resolution of escalated member, pharmacy and provider inquires related to the prescription drug benefit by working directly with the pharmacy benefits manager (PBM) and other designated pharmacy vendors.
• Monitor prior authorization requests and coordinate coverage decisions for review to clinical staff, PBM, or appeals and grievances team for review.
• Supports the clinical pharmacy staff as needed.
• Supports oversight and monitoring of pharmacy benefits manager (PBM) including review of formulary marketing materials, claims adjudication testing, quality review of reporting, and participation in weekly account calls.

Supervision Exercised:

* None.

Supervision Received:

* General supervision received daily.

Qualifications:

Education Required:

* HS Diploma or GED required.

Education Preferred:

* Associates degree or an equivalent combination of education, training and experience preferred.

Experience Required:

* Two or more years of experience in a professional setting.

* Two or more years of prior pharmacy experience required.

Experience Preferred/Desirable:

* Prior customer service experience.

* Prior managed care experience in a Medicare Plan.

Required Licensure, Certification or Conditions of Employment:

* Successful completion of pre-employment background check.

Competencies, Skills, and Attributes:

• Strong oral and written communication skills.
• Ability to make reasonable and sound business decisions based on established BMCHP standards and guidelines.
• Ability to work effectively in a team environment.
• Organized, able to multitask between projects, and meet deadlines.
• A strong working knowledge of Microsoft Office products.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Ability to work in a fast paced environment.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

Compensation Range:

$20.19 - $28.13

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees