Pharmacy Programs Specialist

Clover Health
United States
Workplace: RemoteFull timeUSD 53,800 - 70,000 annuallyFunction: Communications, PR & CommunityExperience: 3+ yearsEducation: certificationSkills: ["Communication","Problem-solving","Critical thinking","Attention to detail","Collaboration"]

Support Medicare quality metrics and medication management initiatives within the Clinical Pharmacy team. Validate claim adjudication to ensure appropriate access to care, conduct telephonic outreach to members and providers, and maintain electronic medical records. Resolve Part D Star measure root causes, analyze PBM delegated-function data to recommend process improvements, and guide pharmacy clinical/regulatory workflows. Collaborate cross-functionally, lead Part D knowledge training, and help drive operational metrics and CMS compliance.

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Clover Health
Clover Health
4 days ago

Pharmacy Programs Specialist

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Source: Company careers pageValidated by: Fursa AI
Last checked: 1 hour agoStatus: Live

Job Summary

Support Medicare quality metrics and medication management initiatives within the Clinical Pharmacy team. Validate claim adjudication to ensure appropriate access to care, conduct telephonic outreach to members and providers, and maintain electronic medical records. Resolve Part D Star measure root causes, analyze PBM delegated-function data to recommend process improvements, and guide pharmacy clinical/regulatory workflows. Collaborate cross-functionally, lead Part D knowledge training, and help drive operational metrics and CMS compliance.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Communications, PR & Community
Seniority: Mid level

Key Responsibilities

  • •Create, manage, and respond to cases, escalating to Clinical Pharmacists as needed.
  • •Contribute to Part D Star measures by resolving root causes of medication management issues and providing recommendations based on profile review or patient interview.
  • •Validate claim adjudication for appropriate access to care and provide telephonic support to plan members, prescribers, and pharmacies.
  • •Collect and present PBM delegated-function data and trends, proposing process improvements to cross-functional operational workgroups.
  • •Provide guidance on pharmacy clinical and regulatory workflows, lead Part D knowledge training, and help with quality assurance reviews and report validation for CMS compliance.

Pay and Benefits

Salary: USD 53,800 - 70,000 annually
Equity and Bonus:Equity
Perks:Health InsuranceDentalVision401kEquityAnnual BonusRemote WorkPaid LeaveLearning Budget

Key Requirements

  • •National Certification (CPhT) Pharmacy Technician License (preferred).
  • •At least three (3) years of experience working in pharmacy, managed care organization, medical office, or in a hospital setting.
  • •Fluency in English and Spanish, both orally and in writing.
  • •Understanding of managed care.
  • •PC skills in Windows-based applications.
Experience:3+ yearsPharmacyManaged careHealthcare
Education:Certification / Diploma
Skills:CommunicationProblem-solvingCritical thinkingAttention to detailCollaboration
Licenses:Pharmacy Technician License (CPhT)
Certifications:CPhT
Languages:EnglishSpanish
Tech Stack:WindowsElectronic medical records (EMR)Telephonic outreachKnowledge base

Company Brief

Clover Health
Clover Health is a technology-driven health insurance company offering Medicare Advantage plans that combine clinical care coordination, data analytics, and value-based care to improve outcomes and reduce costs for seniors.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Jersey City, United States
Founded: 2014
WebsiteLinkedIn