Pharmacy Liaison/PBM Specialist
AlohaCare - Honolulu, HI

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The primary responsibility of this position is to serve as liaison between the pharmacy network, AlohaCare (AC), and AC’s Pharmacy Benefit Manager (PBM) to ensure on-going quality service delivery to AC’s QUEST and Part D pharmacy networks. This involves being the point of contact for pharmacy and physician escalated complaints and close coordination/interface with AC’s PBM, AC Provider Networks, the AC Clinical Operations/Pharmacy Manager, AC Marketing, AC Claims, AC Customer Service, AC Plan Operations, and various other AC Departments.

Primary Duties and Responsibilities:
  • Educate Providers and the pharmacy network on AlohaCare’s philosophy, the pharmacy benefits, AC’s Formularies, and the Coverage Determination/Prior Authorization process, which includes presentations to small and large groups.
  • Work with AC Depts, network pharmacies and PBM to ensure timely issue resolution.
  • Assist pharmacy and physician providers on drug claims related activities and interface with various AC departments and/or the PBM as needed to ensure prompt payment.
  • Develop, coordinate internal approval process, and production of pharmacy benefit and formulary management communications for internal and external distribution.
  • Develop and maintain the QUEST and Part D pharmacy network directories for internal and external distribution.
  • Work with AC Clinical Operations Manager, AC Provider Relations, and/or the PBM to resolve operational issues that affect the pharmacy network and other network Providers.
  • Understand AC’s business objectives to assist AC’s Pharmacy Manager in pharmacy contracting, specialty drugs, and other opportunities.
  • Review policies and procedures related to pharmacy network management.
  • Monitor delegated PBM services related to the pharmacy network.
  • Understand and ensure compliance with State, Federal, and Accreditation requirements related to the pharmacy network.
  • Assist Provider Relations in educating the non-pharmacy Provider network regarding the pharmacy benefits, AC’s Formularies, and the Pharmacy & Therapeutics Committee process
  • Assist Marketing in educating members regarding their pharmacy benefits.
  • Upload reports from PBM to specific AlohaCare assignees (i.e. Pricing Files, Rebates, PDE, etc).
  • Manage/initiate Ad-Hoc reports as needed for AlohaCare in relation to PBM.
  • Manage special projects as assigned.
  • Other duties as assigned
Required Competencies and Qualifications:
  • 1 year of experience in retail pharmacy
  • Excellent communication skills (written and verbal)
  • Strong organizational and time-management skills
  • Team player
  • Self-motivated
  • Demonstrated professionalism both externally and internally
  • Positive work ethic and willingness to go “above and beyond” when necessary
  • Able to work with limited supervision
Required Education, Licensure or Certification:
  • College Degree in related field preferred
Preferred Competencies and Qualifications:
  • 1 year of pharmacy network management experience
  • 2 years of managed care experience
  • Proficient in Word, Excel, PowerPoint, and basic Access data bases desired
Additional Job Requirements:
  • Learn and develop experience in the use of AlohaCare’s information system, QMACS, and AlohaCare’s historical data bases
  • Learn and develop experience in the use of Medco Health Solutions Client website and various reporting tools (ExPER x T) as well as the claims and authorization processing platform/system sponsored by the PBM.
  • Travel to Neighbor Islands may be needed periodically

AlohaCare - 18 months ago - save job - block
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