A dynamic outpatient clinic in Boston, MA is seeking a dedicated individual to fulfill the role of Pharmacy Operations Specialist. This position involves supporting pharmacy utilization management programs, processing prior authorization requests, and providing exemplary pharmacy-related customer service. Work in a collaborative environment where your contributions impact daily operations, with a commitment to excellence in patient care.

Key Details

• Assignment Type: Locum Tenens
• Setting: Outpatient Clinic
• Start Date: ASAP
• Schedule: Monday–Friday, 8:00 AM – 5:00 PM
• Patient Population: Adult
• Location: Boston, MA
• Stipends: Housing and travel options can be discussed for non-local candidates

Benefits

• Weekly direct deposit
• Malpractice insurance with tail coverage
• Supportive credentialing assistance
• Lodging and mileage reimbursement (if applicable)
• Flexible scheduling

Job Responsibilities

• Receive, process, and review all prior authorization requests via various platforms.
• Apply clinical policy criteria to review prior authorization requests in line with regulatory requirements.
• Analyze member eligibility, claim history, and pharmacy program details using PBM software.
• Communicate determination outcomes to members and providers through calls, faxes, and letters.
• Handle analysis and issue resolution for formulary and benefits management.
• Provide customer service to internal and external parties regarding pharmacy-related inquiries.
• Process pharmacy authorizations utilizing real-time claims adjudication software.
• Support the implementation of new clinical programs and serve as a liaison for real-time support.

Qualifications

• Minimum of a High School diploma or equivalent; Associate or Bachelor's degree preferred.
• Two or more years of professional or pharmacy setting experience required.
• Experience in a managed care environment and customer service preferred.
• Pre-employment background check required.

Working Hours

• Monday through Friday, 8:00 AM – 5:00 PM.

Skills

• Excellent customer service skills with previous experience in handling inquiries.
• Strong organizational, problem-solving, communication, and interpersonal skills.
• Proficient in written and oral communication.
• Attention to detail with strong data entry skills.
• Ability to multitask and prioritize results effectively.