Benefit Administration Pharmacist

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

The Benefit Administration Pharmacist (BA RPh) shall be responsible to research initial coverage determinations, coordinate clinical peer review, prepare written responses to appeal requests. In addition, the BA RPh will review and make decisions on contractual pharmacy appeal cases. During times that there are no appeal tasks to complete, the BA RPh will assist the Supervising Pharmacist, Prior Authorization in any tasks that are deemed necessary for the PBD Prior Authorization and PBD Benefit Administration teams.

• Licensed to practice pharmacy in New York State required (registered pharmacist degree); PharmD preferred.

• Four (4) years of clinical experience required; Utilization Management experience preferred.

• Comprehensive knowledge and experience with managed care benefit plans.

• Demonstrated ability in researching and assisting clinical team in rendering coverage determinations in accordance with member contract and policy.

• Excellent communication verbal, written and interpersonal communication skills required.

• Demonstrated ability to handle escalated calls and to clearly and articulately deliver messages regarding decisions.

• Solid PC and navigational skills required. Knowledge of Siebel, Macess and RxAuth is a plus.

• Possess initiative and solid, logical thinking capabilities.

• Proven ability to manage multiple, time-sensitive priorities and adherence to all deadlines, while remaining organized.

• Ability to work a flexible schedule required.

• Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

• Research

  • Investigate clinical (pharmacy) appeals, utilizing appropriate internal and external resources to ensure coverage determinations are consistent and within member benefit contract.

  • Investigate and research all levels of contractual pharmacy complaints/appeals independently to ensure decisions are within accordance of applicable policies, procedures and contracts.

  • Complete special projects when assigned.

• Accountability

  • Ensure verbal and written response to appeals and regulatory investigations are in compliance with regulatory standards.

  • Provide member education/outreach related to coverage determinations and member benefit contract.

  • Investigate and make decisions on pharmacy contractual cases.

• Coordination

  • Coordinate and oversee the clinical peer review of appeals and assist the clinical team in rendering consistent coverage determinations in accordance with policy and member benefit contract.

• Reporting

  • Complete log worksheet to maintain consistency in logging complaints/appeals.

  • Maintain and monitor outstanding case logs to plan and prioritize workload.

  • Identify appeal trends and process improvements where applicable.

• Continuous Improvement

  • Assist in continuously developing systems, workflows and coverage criteria to better meet the needs of the customers based on measurement and evaluation of clinical appeal data.

• Departmental Support

  • Assist in meeting department goals and objectives and identifying process improvements to continuously improve member/provider satisfaction.

  • Attend assigned meetings as department representative (i.e. P&T Committee) and reports to team members when necessary.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $110,000 - $130,000 annually

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.