ABOUT US
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary: The Coordinator, Pharmacy Benefits shall support the efforts of the clinical pharmacy teams of both Florida Complete Care’s Medicare Part D and Florida Community Care’s Medicaid pharmacy benefit programs. The successful candidate will be able to collaborate with prescribers and targeted beneficiaries to ensure appropriate payment determination, evidence-based drug selection, and resolve medication-related problems.
Essential Functions:
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Support basic data analytic activities and tracking of metrics, claims and interventions.
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Assist with preparation and documentation of responses to regulatory audits.
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Monitor medication therapy management (MTM) services through prescriber follow-up and collaborations with other departments.
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Document and record oversight/activities in appropriate databases/software to ensure compliance with CMS and Florida Medicaid requirements.
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Consult with pharmacists and/or physicians regarding the use of medications and advise of appropriate formulary alternatives when requested.
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Respond to inquiries from other departments, physicians, and members related to formulary and prescription benefits.
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Engage in drug utilization review (DUR) by supporting letter campaigns, and telephonic outreach to members/providers.
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Participate in various pharmacy benefit-related projects. Complete assigned reports for pharmacist review as needed.
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Complete member-related tasks within the same business day whenever possible. Address member concerns in a timely manner.
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Refer all prescribers (MD, DO, APRN etc.) and customer calls related to medical questions to the Pharmacist.
Education & Experience:
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State of Florida Registered Pharmacy Technician License (RPT) required.
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Managed Care Pharmacy experience, required.
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PBM operations experience, preferred.
Required Skills:
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Bilingual (English/Spanish), preferred
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Knowledge of pharmaceutical generic and brand names
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Strong Microsoft software and computer skills (Word, Excel, PowerPoint, Access, Outlook)
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Programming or Reporting software skills, desired.
EEO STATEMENT
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.