Clinical Pharmacy Specialist-2 (Healthcare)

TL;DR

Clinical Pharmacy Specialist-2 (Healthcare): Supporting Medicare and D-SNP coverage review activities to ensure appropriate pharmacy benefit access with an accent on claim adjudication and coverage determinations. Focus on managing provider cases, auditing pharmacy reports, and resolving claims issues in a remote environment.

Location: Remote (USA). Schedule: Monday-Friday 8AM-6PM EST, must be available to work nights and weekends on a rotating basis

Company

hirify.global is a leading health insurance provider focused on delivering high-quality pharmacy benefits and member care.

What you will do

• Perform coverage reviews for Medicare and D-SNP plans to ensure timely member access to benefits.
• Process authorizations and test claims within the pharmacy benefit system for correct adjudication.
• Manage incoming and outgoing communications with providers and members regarding coverage determinations and appeals.
• Monitor pharmacy reports and handle internal inquiries via email and FACETs.
• Support departmental audits and quality improvement initiatives.
• Participate in on-call rotations, including evenings, holidays, and weekends.

Requirements

• National Certification as Pharmacy Technician (PTCB).
• Minimum 2 years of pharmacy experience.
• Availability to work 8AM-6PM EST, including rotating nights and weekends.
• High School Diploma or equivalent.
• Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Knowledge of medical and pharmacy terminology.

Culture & Benefits

• Remote-friendly work environment with provided tools and resources.
• Culture of innovation and continuous learning.
• Balance of independent work and team collaboration.
• Support for professional growth and creativity.