Pharmacy Program Specialist - SpanishEnglish Bilingual
Pharmacy Program Specialist - SpanishEnglish Bilingual
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$ 50400 - 63000
1 Vacancy
Job Description
At Clover Health we are committed to providing highquality affordable and easytounderstand healthcare plans for Americas seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each members complete health history we ensure better care at a lower costdelivering the highest value to those who need it most.
The Clinical Pharmacy team is an innovative team that utilizes a membercentric approach to provide comprehensive medication management services. The Pharmacy Programs Specialist will work to support Medicare quality metrics medication management initiatives and maintain Centers for Medicare and Medicaid Services compliance standards.
In this role you would perform validation of claim adjudication ensuring appropriate access to care and support telephonic outreach for plan members providers and other healthcare professionals. In addition document activity and maintain electronic medical records while providing the highest quality healthcare and service to plan members and other internal and external partners.
As a Pharmacy Programs Specialist you will:
- Create manage and respond to cases and/or escalate to Clinical Pharmacists on the Team.
- Contribute to improving Part D Star measures by resolving root causes of medication management problems and taking appropriate action to provide recommendations based on profile review or patient interview.
- Represent for the Pharmacy team and participate in crossfunctional team meetings
- Collect and present data and trends from Pharmacy Benefits Manager (PBM) delegated functions to crossfunctional operational workgroups to propose process improvements
- Deliver on crossfunctional team initiatives and adhoc projects that impact Clover business goals
- Provide guidance to internal and external teams in regards to pharmacy clinical and regulatory workflows policies and processes
- Serve as a liaison between PBM Account Management Team and Clover Health and escalate any questions that need PBM involvement for resolution.
- Organize pharmacy team meetings with internal and external partners.
- Think critically and problem solve to prioritize and work more efficiently
- Improve teams capacity and knowledge
- Distribute work to peers and strategize completion of quality assurance projects that require short turn around times
- Provide recommendations on and deliver Part D content knowledge updates on internal knowledge base directory annually and adhoc
- Lead educational training for cross functional teams on Part D knowledge and vendor platforms
- Participate in call center quality assurance reviews
- Perform strategic work to increase MTMP Star measure
- Navigate and use tools and platforms required for task/queuebased work
- Show curiosity as to how work impacts the business and how that work is generated
- Complete a larger volume of assigned tasks with increasing focus on program/projectbased opportunities and work and serve as a resource to others
- Communicate with the pharmacy leadership team in a timely manner when issues arise.
- File review and validate reports to ensure compliance with Medicare guidelines.
- Gather data and generate reports to improve clinical pharmacy quality metrics.
- Participate in training and orientation of new team members as needed.
- Execute other job duties as assigned.
Success in this role looks like:
- Within 90 days: You have seamlessly integrated into the Pharmacy team and completed all the necessary training modules familiarize yourself with the organizations platforms and established a strong knowledge of Clover Health Part D benefit. You are capable of validating claim adjudication to ensure appropriate access to care and provide telephone support to plan members prescribers and pharmacies.
- Within 6 months: You will be fully engaged in oversight of accurate Part D benefits that are in compliance with CMS requirements. You have demonstrated the ability to collaborate effectively with interdisciplinary teams providing member experience support and contributing to resolving member medication related escalations.
- Longterm: You will be measured based on pharmacy operational metrics the integration of innovative technologies to enhance pharmacy services and improve patient outcomes the enhancement of operational efficiency and contributions to achieving the organizations strategic objectives and key results.
You should get in touch if:
- You have a National Certification (CPhT) Pharmacy Technician License (preferred).
- You have at least three 3 years of experience working in pharmacy managed care organization medical office or in a hospital setting.
- You are fluent in English and Spanish both orally and in writing.
- You have an understanding of managed care.
- You have PC skills in Windowsbased applications.
- You have excellent written and oral communication skills.
- You are able to work Eastern Time (ET) hours; candidates in this time zone preferred.
Benefits Overview:
- Financial WellBeing: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally we offer a performancebased bonus program 401k matching and regular compensation reviews to recognize and reward exceptional contributions.
- Physical WellBeing: We prioritize the health and wellbeing of our employees and their families by providing comprehensive medical dental and vision coverage. Your health matters to us and we invest in ensuring you have access to quality healthcare.
- Mental WellBeing: We understand the importance of mental health in fostering productivity and maintaining worklife balance. To support this we offer initiatives such as NoMeeting Fridays monthly company holidays access to mental health resources and a generous flexible timeoff policy. Additionally we embrace a remotefirst culture that supports collaboration and flexibility allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs mentorship professional development funding and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remotefirst culture enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken so weve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and missiondriven individuals with diverse areas of expertise working together to solve the most complicated problem in the world: healthcare.
From Clovers inception Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths experiences perspectives opinions and backgrounds who share a passion for improving peoples lives. Diversity not only includes race and gender identity but also age disability status veteran status sexual orientation religion and many other parts of ones identity. All of our employees points of view are key to our success and inclusion is everyones responsibility.
#LIREMOTE
Pursuant to the San Francisco Fair Chance Ordinance we will consider for employment qualified applicants with arrest and conviction records. We are an EVerify company.
For California Colorado New Jersey New York or Washington residents a reasonable estimate of the base salary range for this role can be found below. For candidates residing in other geographic areas the range will be adjusted based on location. Final pay is based on several factors including but not limited to internal equity market data and the applicants education work experience certifications etc.
Colorado/Washington Pay Range
$50400 $63000
California/New Jersey/New York Pay Range
$50400 $70000
Required Experience:
Unclear Seniority
Employment Type
Full Time
