Pharmacy Operations Manager

Trillium Professional is now seeking a remote Pharmacy Operations Specialist!

Summary

• Support pharmacy utilization management programs through prior authorization processing, pharmacy benefit interpretation, and member/provider customer service.
• Reports to the Manager of Pharmacy Operations; no direct reports.

Responsibilities

• Receive, process, and review prior authorization requests submitted by fax, phone, and electronic systems.
• Apply clinical policy criteria and document medical and pharmacy information accurately.
• Review member eligibility, claims history, pharmacy benefits, and formulary information using PBM software.
• Communicate determinations to members and providers through calls, faxes, and letters.
• Resolve pharmacy benefit and formulary issues.
• Process pharmacy authorizations using PBM online claims adjudication software.
• Support clinical program implementation and provide pharmacy guidance to internal teams.
• Follow regulatory and NCQA documentation requirements.

Pay rate is $23/hour.

Required Qualifications

• High school diploma or equivalent.
• Two or more years of experience in a professional or pharmacy setting.
• Strong customer service, communication, organization, problem-solving, and data entry skills.
• Ability to multitask and maintain accurate case documentation.
• Pre-employment background check.

Preferred Qualifications

• Associate’s or bachelor’s degree.
• Managed care experience.
• Previous customer service experience.

Trillium is an Equal Opportunity Employer.