Capital Blue Cross · 12 hours ago
Pharmacy Coordinator
US-PA-Harrisburg
Full-time
Onsite
Mid Level
$48K/yr - $91K/yr
3+ years expCapital Blue Cross is committed to improving the health and well-being of its members and communities. The Pharmacy Coordinator position is responsible for coordinating the Commercial and Medicare Part D prescription drug benefit plan administration and providing operational support for the Pharmacy Department.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
Provide department operational support, to include but not limited to, benefit plan designs set-ups, Requests for Proposal (RFP) or Request for Information (RFI) responses, database maintenance, report production, benefit/program training and presentations, sales guideline maintenance, member/group educational materials development/maintenance/inventory, and provider manual update
Troubleshoot or translate operational needs into a comprehensive action plan and take the lead in its execution
Identify, plan, develop, implement, and monitor performance of new pharmacy benefits and programs to maximize market position
Handle benefit, group/member, or operational issues using interpersonal and team skills
Track and document issues/projects to ensure timely and complete resolution/ deployment
Manage assigned projects with detailed project plans and methodologies, effective work teams, and creative/innovative solutions, which meet or exceed established project objectives
Assist to identify operational and service problems, recommend and implement process enhancements and efficiencies leading to improved departmental productivity
Comprehension of State and Federal Laws/Regulations relating to the administration of Rx Drug Benefits
Serve as a liaison between the pharmacy vendor(s) and various internal departments to coordinate immediate benefit or coverage needs of members as well as to prioritize and direct the pharmacy steering work group activities
Handle escalated or complex customer inquiries and complaints concerning the prescription benefit in a timely, objective, and accurate manner
Apply clinical criteria and analytical experience to perform prior authorization reviews
Qualification
Required
3 years relevant experience
Must have high school diploma or GED
Proficient research and analytical skills
Strong organizational skills to manage day-to-day activities, coordinate multiple tasks, monitor and document issues/projects to ensure timely and complete resolution, and manage time effectively
Strong communication skills; effectively communicate (verbally and in writing) with all levels of plan personnel and external contacts with professionalism (courtesy, persuasion and tact)
Strong interpersonal and team skills with ability to work and interact externally and internally to handle benefit, group/member, or operational issues
Ability to meet stringent deadlines and handle rapidly changing priorities with minimal supervision
Ability to track and document issues/projects to ensure timely and complete resolution/deployment
Strong project management skills to manage assigned projects with detailed project plans and methodologies, effective work teams, and creative/innovative solutions, which meet or exceed established project objectives
Ability to troubleshoot or translate operational needs into a comprehensive action plan and take the lead in its execution
Ability to take direction from and perform project work for various levels of staff
Ability to operate a PC and applications, such as; Word, Excel, PowerPoint, Access and other Pharmacy reporting software
Knowledge and experience in the pharmacy industry, pharmacy benefit manager, and understanding prescription claims processing
Comprehension of State and Federal Laws/Regulations relating to the administration of Rx Drug Benefits
Preferred
Prefer a Bachelor's degree in Business Administration, Healthcare Administration in a health science field or previous work experience with pharmacy benefit administration or in the PBM industry
Preference will be given to candidate with a relevant pharmacy related training, certification, or degree
Experience with drug utilization review (DUR) and prior authorization review
Experience with presentation in a variety of audiences and settings
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Todd Shamash
President and CEO
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
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