Pharmacy Coordinator

Medica's Pharmacy Coordinator supports the implementation and daily operations of prescription drug benefits across all health plan business lines. The Pharmacy Coordinator will work closely with internal teams and external partners-including PBMs, medical directors, and customer service-to ensure accurate benefit delivery and regulatory adherence.

Key Responsibilities

Operational & Clinical Support

• Prepare and support utilization management (UM) cases.
• Manage medical policy documentation and updates.
• Serve as a liaison for benefit coding of drugs requiring prior authorization.

Compliance & Auditing

• Support internal and external audits related to all lines of business.
• Assist with program monitoring and documentation for regulatory compliance.

Vendor & Program Oversight

• Oversee pharmacy benefit manager (PBM) performance and coordination.
• Provide backup support to the Pharmacy Program Manager.

Communication & Customer Service

• Respond to inquiries from providers and internal teams.
• Assist with customer service escalations related to pharmacy benefits.
• Draft and distribute provider communications.

Qualifications

• Bachelor's degree in a business-related field, or equivalent combination of education and experience.
• Experience in healthcare, managed care, or health plan operations strongly preferred.

Skills & Competencies

• Proficiency in Microsoft Word and Excel.
• Familiarity with healthcare systems and platforms (e.g., EMRs, claims systems).
• Knowledge of utilization management, prior authorization, and appeals processes.
• Understanding of medical claims and injectable drug coding.
• Strong analytical and problem-solving skills.
• Excellent verbal and written communication abilities.
• Ability to work independently and collaboratively in a team environment.
• High attention to detail and strong organizational skills.
• Flexibility to adapt to changing procedures and priorities.

Preferred Qualifications

• Certification or licensure (e.g., CPhT, RN) is a plus.
• Experience working with integrated delivery networks (IDNs) or Medicare Advantage and commercial plans.

This position is a hub-based role which requires onsite presence. To be eligible for consideration, candidates must reside within a commuting distance to one of the following office locations: Minnetonka, MN or Madison, WI or Omaha, NE. Onsite frequency is determined by business need as decided by leadership and may be up to 2-3 days a week.

The full salary range for this position is $49,800-$85,300. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.