Pharmacy Program Specialist

Summary

Join Clover Health, a company dedicated to providing high-quality, affordable healthcare plans for seniors, as a Pharmacy Programs Specialist. You will play a crucial role in supporting Medicare quality metrics, medication management initiatives, and maintaining compliance standards. This position involves validating claim adjudication, providing telephonic outreach to members and providers, documenting activity, and maintaining electronic medical records. You will also contribute to improving Part D Star measures, participate in cross-functional team meetings, and deliver on initiatives that impact Clover's business goals.

Requirements

• 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 Windows-based applications
• You have excellent written and oral communication skills

Responsibilities

• 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 cross-functional team meetings
• Collect and present data and trends from Pharmacy Benefits Manager (PBM) delegated functions to cross-functional operational workgroups to propose process improvements
• Deliver on cross-functional team initiatives and ad-hoc 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 team’s 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 ad-hoc
• 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/queue-based 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/project-based 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

Preferred Qualifications

• You have a National Certification (CPhT) Pharmacy Technician License (preferred)
• You are able to work Eastern Time (ET) hours; candidates in this time zone, preferred

Benefits

• Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities
• Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions
• We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage
• We understand the importance of mental health in fostering productivity and maintaining work-life balance
• To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy
• Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location
• Developing internal talent is a priority for Clover
• We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews
• Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
• Reimbursement for office setup expenses
• Monthly cell phone & internet stipend
• Remote-first culture, enabling collaboration with global teams
• Paid parental leave for all new parents