Coordinator, Pharmacy Operations Jobs

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Why We’re Worth the Application:

• Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
• We continue to grow year over year.
• Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.
• Named to Parity.org’s list of the best companies for women to advance for 3 years in a row (2020, 2021 and 2022).
• Publish an annual DE&I report to share our progress on how we’re building an equitable workplace.
• Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts.

What You’ll Be Doing:

The Role

The Evolent pharmacy team is looking for a highly motivated and energetic Coordinator, Pharmacy Operations to join the Pharmacy Services team. We are looking for team members that possess high-energy, a strong work ethic, integrity, who are kind and empathetic, have a sense of humor, and who enjoy working for a collaborative, team-oriented system. Responsibilities are varied as described below and dependent on business need. This position requires someone who is highly organized, detail-oriented, personable, and able to adapt to a dynamic working environment.

Responsibilities

Overall

• Ability to adapt to a changing environment, including scheduling flexibility.
• Consistently meet established productivity requirements, adherence to schedule and quality standards.
• Always maintain confidentiality of protected patient medical information.
• Perform ad-hoc projects to support pharmacy operation initiatives.
• Navigate across multiple systems to respond to questions from external and/or internal partners.
• Develop and maintain workflows and other training materials.

Utilization Management (UM) Responsibilities:

• Process patient submitted Direct Member Reimbursement (DMR) claims and support the appeal and grievance process related to pharmacy clinical determinations.
• Review and approve, as applicable, member and provider inquiries for prior authorization requests based on established pharmacy guidelines and state and federal requirements.
• Coordinate, compile and oversee the management of third-party external reviews for Medicare, Commercial and Medicaid lines of business.
• Perform quality review of prior authorization requests to ensure adherence of established pharmacy guidelines and state and federal requirements.
• Providing general prior authorization information via telephone, fax or email to providers, members and/or Evolent client partners.
• Perform outbound notifications to members and/or providers notifying them of prior authorization outcomes.
• Receive and review prescription prior authorization (PA) requests from providers and members via telephone, fax, email, and web-enabled submissions (e.g., electronic PA).
• Perform outbound calls to provider and/or members to solicit information needed to process a prior authorization request, follow-up on PA requirements and/or provide consultation on the prior authorization program.

Required Qualifications

• Willingness to work evenings (until 7pm EST), as needed.
• Available to work holidays on a rotation.
• Available to work every other weekend.

Preferred Qualifications

• Experience at a health plan or PBM
• Experience with MHK (formerly MedHOK)
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and ability to learn multiple work-related software applications.
• Associate or bachelor’s degree
• Certified pharmacy technician (CPhT)

Skills And Behavioral Attributes

• Navigate ambiguity with structured problem-solving and decision-making.
• Strong work ethic built on a foundation of proactivity.
• Ability to make independent decisions.
• Committed to team-oriented work environment.
• Committed to the practice of inquiry and listening.
• Exceptional interpersonal, presentation, oral and written communication skills

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range: The minimum salary for this position is $18.00, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.