Clinical Pharmacy Specialist

Description

• Respond to calls and requests from providers, members, and member representatives regarding pharmacy prior authorizations, exceptions, and appeals.
• Perform system edits, data entry, and maintain tracking logs.
• Assist with departmental audits and quality improvement initiatives.
• Enter authorizations and test claims into the pharmacy benefit system to ensure accurate claim adjudication.

Requirements

• Ability to work independently with minimal supervision
• Excellent oral and written communication skills
• Strong interpersonal skills and attention to detail
• Proficient in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)
• Knowledge of medical terminology
• PTCB certification
• Strong organizational skills with the ability to manage multiple projects
• Proven decision-making and problem-solving abilities

Benefits

• Employee Assistance Program
• Transportation benefits
• Critical Illness, Accident, and Hospital
• Short and long-term disability
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 19, 2026.
• Health Spending Account (HSA)
• Medical, dental & vision

Training + Development

Interview process

Visa Sponsorship

Security clearance