Job Overview – Pharmacy Operations Specialist (Remote):
Compensation: $30 – $32/hour
Schedule: Monday to Friday (Remote)
Atlantic Group is hiring a Pharmacy Operations Specialist (Remote) for our client, supporting pharmacy benefit operations within a managed care environment. This fully remote role focuses on prior authorization processing, formulary support, and PBM system review while ensuring compliance with regulatory and NCQA standards. You will interpret clinical and pharmacy data, communicate determinations to members and providers, and support day-to-day pharmacy operations.
Responsibilities as the Pharmacy Operations Specialist (Remote):
- Prior Authorization Processing: Receive, review, and process pharmacy prior authorization requests in compliance with regulatory and accreditation requirements.
- Clinical Criteria Application: Apply clinical policy criteria to ensure accurate and appropriate authorization decisions.
- PBM System Review: Review member eligibility, claims history, and pharmacy benefit information using PBM systems.
- Provider & Member Communication: Communicate authorization determinations and benefit information to providers and members through multiple channels.
- Data Entry & Operational Support: Enter accurate pharmacy and medical data while supporting formulary administration and daily pharmacy operations.
Qualifications for the Pharmacy Operations Specialist (Remote):
- Education: High school diploma required, with an associate or bachelor’s degree preferred.
- Experience: 2+ years of experience in a pharmacy, healthcare, or operations setting required, with managed care or PBM experience preferred.
- Technical Skills: Strong data entry skills and attention to detail when building and managing authorization cases within pharmacy systems.
- Industry Knowledge: Familiarity with pharmacy benefits, prior authorization workflows, and clinical policy application, with experience supporting member and provider inquiries preferred.
- Skills & Attributes: Detail-oriented professional with strong communication and problem-solving skills, able to multitask effectively in a remote environment.
Application Notice: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, Atlantic Group will keep your resume on file for future opportunities and may contact you for further discussion.