Job Overview – Remote Pharmacy Quality Coordinator (Medicare):
Compensation: $30 – $33/hour
Schedule: Monday to Friday (Remote)
Atlantic Group is hiring a Remote Pharmacy Quality Coordinator to support our client’s Medicare pharmacy quality initiatives. You will conduct outreach, monitor Medicare Part D claims, and coordinate with the pharmacy benefits manager (PBM) to resolve issues. This role focuses on improving medication adherence, reducing readmissions, and ensuring compliance with Medicare Advantage requirements.
Responsibilities as the Remote Pharmacy Quality Coordinator:
- Member & Provider Outreach: Drive Medicare Advantage quality initiatives by conducting outreach to members and providers to improve medication adherence and care outcomes.
- Claims & Quality Oversight: Review and resolve Part D claims rejects, oversee transitions of care, and ensure accurate adjudication of pharmacy benefits.
- PBM & Vendor Coordination: Collaborate with PBMs and pharmacy vendors to troubleshoot claims issues, streamline processes, and maintain CMS compliance.
- Provider Communication: Develop and distribute provider communications that support clinical best practices and ensure timely access to medications.
- Collaboration: Partner with internal teams to resolve escalated issues and support quality improvement.
Qualifications for the Remote Pharmacy Quality Coordinator:
- Education: High school diploma or GED required (Associate’s degree or pharmacy technician certification (CPhT) strongly preferred).
- Experience: 2+ years of pharmacy experience with preferred background in Medicare Advantage or Medicaid managed care and proven healthcare customer service skills.
- Technical Skills: Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint) and familiarity with PBM platforms, pharmacy claims systems, or quality reporting tools.
- Skills & Attributes: Strong communication, organizational, and decision-making skills, with the ability to thrive in a remote, fast-paced team 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.