Remote Jobs
Pharmacy Services Specialist - Aspire Health Plan
What's your preference?
Job Description
- Req#: 2025-1046
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $30.00 per hour
- Full-time remote position, allowing flexibility in work location
- Opportunity for career advancement and growth within the organization
- Supportive work environment with a focus on professional development
- Chance to make a positive impact on patient care and pharmacy services
What to Expect (Job Responsibilities):
- Review and process prior authorization requests for medications under pharmacy and medical benefits
- Communicate coverage determination decisions to physicians, providers, and members
- Assist in maintaining the formulary and processing formulary change requests
- Investigate and resolve prescription-related grievances received by the Plan or PBM
- Support pharmacy audits and monitor delegated PBM functions through report generation
What is Required (Qualifications):
- Minimum A.A. degree
- Active Pharmacy Technician License required
- At least three years of experience in a health plan or PBM performing prior authorization for drugs, particularly Medicare Part B and Part D
- Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite
- Strong written and verbal communication skills
How to Stand Out (Preferred Qualifications):
- Basic knowledge of medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-10, CMS 1500, etc.)
- Excellent phone manner and ability to handle multiple phone lines
- Ability to communicate effectively with diverse stakeholders
- Problem-solving skills and the ability to make sound decisions under uncertainty
#HealthcareServices #Pharmacy #RemoteWork #CareerOpportunity #PatientCare
We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
The best remote jobs for you
Notice
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report. NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.