Specialty Rx Coordinator in United States at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Specialty Rx Coordinator based in the United States.

We are seeking a detail-oriented Specialty Rx Coordinator to support the administration of specialty pharmacy and medical benefit programs in a fully remote environment. In this role, you will serve as a key liaison between pharmacies, prescribers, members, and external vendors to coordinate prior authorizations, manage appeals, and resolve complex medication-related issues. You will help members navigate financial concerns related to specialty medications while ensuring accurate documentation and timely communication. The position also involves coordinating single case agreements, supporting vendor programs, and maintaining compliance with contractual and regulatory requirements. You will collaborate with customer service, plan administration, and client-facing teams to improve processes and deliver a seamless member experience. This opportunity is well suited to an experienced healthcare professional who combines pharmacy benefits expertise with strong analytical, organizational, and communication skills.

• Prior Authorization Management: Collect and review pharmacy and medical records for prior authorization requests, helping manage increased workloads and ensuring requests are handled accurately and efficiently.

• Specialty Medication Coordination: Act as a liaison between retail and specialty pharmacies, prescribers, and members to document requests, communicate decisions, coordinate appeals, and address medication-related concerns.

• Single Case Agreements: Arrange and negotiate single case agreements, coordinate pricing, process claims accurately, update member records in the QicLink system, and provide ongoing agreement support.

• Member Financial Assistance: Assist members who express financial concerns about specialty medications and communicate escalated issues to the appropriate teams.

• Vendor Program Coordination: Submit referrals to third-party vendors responsible for specialty carve-out programs and serve as a liaison during program implementation and ongoing operations.

• Contract and Regulatory Compliance: Review existing and proposed vendor plan language to assess its impact under applicable governmental regulations, ensuring continued compliance with contractual requirements throughout the revenue cycle.

• Cross-Functional Collaboration: Work with customer service, plan administration, and other internal departments to develop and implement vendor-related policies and group plan language.

• Escalation Management: Coordinate vendor-related questions, resolve issues, and provide status updates to client executives, client service teams, and customer service representatives.

• Process Improvement: Collaborate with internal teams to improve communication, workflows, and service delivery between members, healthcare facilities, and vendors.

• Additional Responsibilities: Perform other duties as assigned to support medical management and specialty pharmacy operations.

• Education: Bachelor's degree or equivalent professional work experience.

• Relevant Experience: At least five years of professional experience, including a strong understanding of pharmacy and medical benefits, specialty medications, J-codes and their administration, limited-distribution drugs, and specialty pharmacy manager selection.

• Prior Authorization Expertise: Previous experience managing pharmacy and/or medical prior authorization requests is required.

• Clinical and Medication Knowledge: Familiarity with medications used in rheumatoid arthritis (RA), transplantation, Hepatitis C, infectious diseases, and/or oncology is preferred.

• Communication Skills: Excellent written and verbal communication skills, with the ability to explain complex information clearly and coordinate effectively with members, providers, vendors, and internal teams.

• Organization and Attention to Detail: Strong organizational skills and a high level of accuracy when managing records, claims, agreements, and documentation.

• Time Management: Proven ability to meet deadlines, prioritize competing tasks, and manage responsibilities effectively in a fast-paced environment.

• Analytical and Problem-Solving Skills: Ability to evaluate information, identify issues, resolve problems, and support sound operational decisions.

• Adaptability and Initiative: Comfortable working under pressure, managing escalations, taking ownership of responsibilities, and collaborating with others to achieve results.

• Technical Proficiency: Proficiency with Microsoft Office Suite or comparable productivity software; familiarity with relevant claims or member management systems is beneficial.

• Core Competencies: Accountability, analytical thinking, collaboration, communication, customer focus, functional expertise, and initiative.

• Remote Work Requirements: Must have a reliable cable broadband or fiber-optic internet connection with minimum speeds of 100 Mbps download and 25 Mbps upload.

• Work Environment: Ability to perform standard desk-based duties involving extended periods of sitting and computer use.

• Annual Salary: $50,000–$55,000, depending on qualifications, experience, and the hiring process.

• Medical Insurance: Access to medical coverage options.

• Dental and Vision Coverage: Dental and vision insurance to support overall health and well-being.

• Life and Disability Insurance: Coverage options designed to provide additional financial protection.

• Paid Time Off: Generous paid time off to support rest, personal needs, and work-life balance.

• Tuition Reimbursement: Financial support for eligible educational and professional development opportunities.

• Employee Assistance Program (EAP): Resources and support for personal and professional well-being.

• Technology Stipend: Financial assistance to support technology needs for remote work.

• Remote Flexibility: Fully remote work, offering the flexibility and comfort of working from home, subject to the required reliable internet connection.