Pharmacy Programs Specialist

1 month ago
Full-time
Mid Level
Project and Program Management
Clover Health

Clover Health

Clover Health is a data-focused health insurance company that is revolutionizing the Medicare Advantage space by integrating innovative technology into its plans. With a focus on optimizing medical outcomes and reducing costs, Clover Health uses analyt...

Insurance
251-1K
Founded 2014
$925M raised

Description

  • Create, manage, resolve, and escalate pharmacy cases to Clinical Pharmacists.
  • Validate claim adjudication and Part D benefits to ensure appropriate access and CMS compliance.
  • Support telephonic outreach to members, prescribers, pharmacies, and healthcare professionals.
  • Improve Part D Star and MTMP measures by resolving medication-management issues and addressing root causes.
  • Collect, analyze, and present PBM data and trends to identify process improvements.
  • Generate, review, and validate reports supporting pharmacy quality metrics and Medicare compliance.
  • Provide guidance on pharmacy clinical, regulatory, and operational workflows to internal and external teams.
  • Coordinate with PBM account management and serve as a liaison between the PBM and Clover Health.
  • Lead training and maintain internal knowledge resources on Part D processes and vendor platforms.
  • Participate in quality assurance reviews, cross-functional initiatives, team meetings, onboarding, and assigned projects.

Requirements

  • At least 3 years of experience in pharmacy, managed care, a medical office, or hospital setting.
  • Nationally certified Pharmacy Technician (CPhT) license preferred.
  • Understanding of managed care and Medicare Part D programs.
  • Fluency in English and Spanish, both spoken and written.
  • Proficiency with Windows-based applications and task or queue-management platforms.
  • Excellent written and verbal communication skills.
  • Ability to work Eastern Time hours; candidates in the Eastern Time Zone preferred.
  • Ability to prioritize work, solve problems, manage high-volume tasks, and collaborate across teams.

Benefits

  • Base salary range of $53,800–$70,000 USD, with equity opportunities and performance-based bonuses.
  • 401(k) matching, regular compensation reviews, and an employee stock purchase plan.
  • Medical, dental, and vision coverage.
  • Remote-first work culture, flexible time off, monthly company holidays, and No-Meeting Fridays.
  • Mental health resources and paid parental leave for all new parents.
  • Professional development funding, learning programs, mentorship, and performance feedback.
  • Office setup reimbursement and monthly cell phone and internet stipend.

Interested in this position?

Apply directly on the company website

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