<p>JOB SUMMARY: Supports the Manager Pharmacy Services with supervision of the pharmacy staff, resolving pharmacy issues, using discretion with facilitation of prior authorizations.</p> <p>KEY RESPONSIBILITIES:</p> <p>Supervises the pharmacy staff, reviews performance and assigns workload to pharmacy staff. Resolves escalated issues related to pharmacy claims processing. Resolves pharmacy issues, using discretion, including the facilitation of prior authorizations, step therapy protocols between physicians. Uploads monitoring activities related to PBM CDNA reports Supports data research for internal and external pharmacy audits Assists in the development of written policies and procedures for process improvements. Leads teams in meeting performance standards. Uses independent judgement to resolves claims adjudication related to pharmacy benefits. Able to effectively handle and manage all elevated pharmacy related calls from members. Serves as a liaison for issues between the pharmacy help desk and PBM. Performs other job-related duties as assigned.</p> <p>QUALIFICATIONS:</p> <p>Ability to read, analyze and interpret complex documents. Demonstrated ability to relate and interact with all types of individuals. Ability to maintain professional courtesy, discretion and confidentiality at all times. Ability to complete tasks in a timely manner. Highly organized and attentive to detail. Proficient in Microsoft applications. Excellent problem solving skills. Bilingual preferred. Possess strong oral and written communication skills. Successful completion of Health Care Sanctions background check.</p> <p>EDUCATION/EXPERIENCE:</p> <p>High School diploma or equivalent. Bachelor's degree preferred. Three year's experience in managed care pharmacy benefits. Prior experience as a Pharmacy Technical Support Specialist I or equivalent experience in a pharmacy setting. Previous experience in a Medicare Advantage Plan preferred. Previous working knowledge of health plan industry including insurance enrollment process. Two year's pharmacy processing claims experience in medical insurance environment or completion of claims training and demonstrated proficiency in research, interpretation and adjudication of claims.</p>