Remote Pharmacy Operations Specialist

Summary: Support pharmacy utilization management programs through prior authorization processing, pharmacy benefit interpretation, and member/provider customer service. Reports to the Manager of Pharmacy Operations; no direct reports.

Responsibilities: Receive, process, and review prior authorization requests submitted by fax, phone, and electronic systems. Apply clinical policy criteria and document medical and pharmacy information accurately. Review member eligibility, claims history, pharmacy benefits, and formulary information using PBM software. Communicate determinations to members and providers through calls, faxes, and letters. Resolve pharmacy benefit and formulary issues. Process pharmacy authorizations using PBM online claims adjudication software. Support clinical program implementation and provide pharmacy guidance to internal teams. Follow regulatory and NCQA documentation requirements. Pay rate is $23/hour.

Required Qualifications: High school diploma or equivalent. Two or more years of experience in a professional or pharmacy setting. Strong customer service, communication, organization, problem-solving, and data entry skills. Ability to multitask and maintain accurate case documentation. Pre-employment background check.

Preferred Qualifications: Associate's or bachelor's degree. Managed care experience. Previous customer service experience. Trillium has been recruiting and placing clerical and office professionals for over 30 years. From Fortune 100 companies to small businesses, our philosophy remains the same: to achieve excellence by providing quality employees with an uncompromising level of service. We believe in honesty, integrity, and a simple philosophy of providing value to our customers and our employees. We strive to be unsurpassed in the recruitment and placement of professionals. Trillium is an Equal Opportunity Employer.