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Wellcare

Pharmacy Formulary Coordinator

Wellcare - Tampa, FL

Pharmacy Formulary Coordinator','1705209','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at www.wellcare.com or view our videos at https://www.youtube.com/user/WellCareHealthPlan.EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!

Department:  Pharmacy Formulary

Reports to:     Manager Formulary Pharmacy

Location:        4110 George Road, Tampa FL 33634

Coordinates and controls the workflow occurring in and out of the department.  Tracks and reviews coding issues and issue resolution for formulary and Preferred Drug Lists (PDLs). Partners closely and coordinates with other pharmacy and functional departments on a frequent basis to ensure synergies and cross-departmental effectiveness.

ESSENTIAL FUNCTIONS

Note: The following is not intended to be an exhaustive list of all duties required of this position

Key Duties and Responsibilities

• Reviews and tracks all aspects of pharmacy claims processing and formulary management for completeness and coding accuracy. (i.e. Medispan information and changes sent to PBM for coding).

•Ensures Medicare formulary and Medicaid PDL information is complete based on the requirements of the specific line of business.

•Updates systems with formulary and preferred drug list changes in accordance to line of business and appropriate effective date timelines.

• Maintains the integrity of the data loaded in to the Formulary Navigator tool for member and provider documents and website searches.

•Performs ongoing claims testing to ensure accuracy of adjudication at Point of Service.

•Researches, troubleshoots and resolves claims issues with internal and external partners.

•Audits the formularies and PDL’s to ensure the terms of agreement have been loaded accurately.

•Provides claims research, analysis, and support during audits (i.e. Acumen, TMPA, CMS program audit, rebate audit)

•Serves as the primary point of contact for the formularies and PDLs to various internal areas; escalating issues to the appropriate partners across the enterprise.

•Elevates and regularly works with both internal and external partners regarding member calls concerning eligibility. (i.e. PBM, Pharmacy Help Desk, Customer Service).

•Tracks requests coming into the department and evaluates trends; involving others as necessary.

•Oversees the weekly and monthly receipt of Third Party Vendor files.

•Supports Formulary leadership on initiatives, tasks and projects related to all aspects of the plans’ pharmacy benefit for all lines of business (e.g. Medicare, PDP, Medicaid)

•Follows all state and federal regulations and contractual requirements, including record retention requirements.

•Performs other duties as assigned.

 

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MINIMUM QUALIFICATIONS

Education

State the minimum required for the job

Education Level         Education Details       Required/Preferred

An Associate's Degree in a related field                    Required

or equivalent work experience                       Required

A Bachelor's Degree in a related field                       Preferred

Work Experience

State the minimum required for the job

Experience Level        Experience Details     Required/Preferred

3 years of experience in       working in pharmacy technician, PBM or pharmacy claims related roles    Required

Licenses and Certifications

List professional licenses and certifications associated with this job

Licenses/Certifications          Other Licenses/Certifications            Required/Preferred

Certified Pharmacy Technician (CPhT)                    Preferred

Skills

State the minimum required for the job

Skill Sets        Other Skills    Proficiency

Ability to effectively present information and respond to questions from peers and management               Intermediate

Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions                Intermediate

Ability to influence  internal and external constituents                    Intermediate

Ability to work in a fast paced environment with changing priorities                     Advanced

Ability to work within tight timeframes and meet strict deadlines              Advanced

Demonstrated analytical skills                      Intermediate

Demonstrated interpersonal/verbal communication skills               Intermediate

Knowledge of healthcare delivery                 Intermediate

Demonstrated organizational skills               Intermediate

Technology

List technical skills associated with the job

Technology     Other Technology       Proficiency     Required/Preferred

Microsoft Excel                      Intermediate   Required

Microsoft PowerPoint                        Intermediate   Required

Microsoft Outlook                  Intermediate   RequiredHealthcare Management Systems (Generic)             Advanced        Required','US-FL-Tampa','4110 George Road','','Tampa','33634','','','No','No','Pharmacy Formulary Coordinator'

13 days 4 hours ago

Wellcare

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Pharmacy Formulary Coordinator Wellcare - Tampa, FL, United States

   

Location: Tampa, FL

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.