Full-Time Pharmacy Program Specialist
Job Description
What you will do:
Pharmacy Benefit Expertise
Serve as a subject matter expert on pharmacy benefit design and trend management; respond to inquiries regarding prescription coverage and member utilization.
Cross-Functional Collaboration
Work with internal teams (Sales, Marketing, Customer Service & Care Management) to triage and research customer needs, analyze market dynamics, and integrate strategies into the pharmacy benefit toolkit.
Employer Group Support
Deliver in person presentations and program performance updates; analyze data and track adoption of benefit options and coordinate cost-saving initiatives across departments.
PBM Partnership, Program Optimization & RFP Compliance
Collaborate with PBM and internal teams to enhance reporting tools, optimize programs, and ensure compliance with benefit design and regulatory requirements. Gather and validate data for RFPs, ensuring accurate, timely responses to assigned questions.
Claims Adjudication Oversight
Review pharmacy benefit rules, resolve coverage issues, and ensure accurate adjudication of claims in alignment with benefit design.
Administrative & Communication Management
Support P&T Committee functions, manage internal requests and member outreach, and facilitate communication between pharmacists and providers for care coordination.
In Person Presentations and Department Meeting Must have the ability to work onsite for internal department meetings and offsite for external client meetings and presentations.
Additional Responsibilities
Perform other duties as assigned to maintain high-quality, cost-effective pharmacy benefit operations.
What you’ll need to succeed:
Knowledge of formularies, drug rebate contracts, and pharmacy benefit design
Knowledge of cost containment and utilization review strategies
Analytical skills specific to pharmacy utilization management and/or project management.
Strong communication, interpersonal and presentation skills.
Proficient in Microsoft Office applications (i.e. Excel, PowerPoint)
The extras:
Combination of education and applicable experience
Three to five years’ experience in managed care or a pharmacy or related healthcare field.
Specific knowledge and exposure to prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology.
Experience with group level presentation and financial analysis reporting on pharmacy trends and benefit performance.
How to Apply
https://www.bcbsri.com/careersApply for this Job
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