Description
Pharmacy Program Specialist II
Houston, TX – Hybrid
Built to Care. Driven to Improve. At Community Health Choice, we’re a nonprofit health plan dedicated to improving the health and well-being of Texans, especially underserved communities. Our employees bring purpose into practice every day through compassion, collaboration, and a commitment to better outcomes.
The Pharmacy Program Specialist II performs a criteria-based review of pharmacy and medical benefit requests in accordance with established clinical guidelines, plan policies, and prior authorization protocols. The role requires a strong understanding of pharmacy and medical benefit drug coverage, and adherence to regulatory timelines. The specialist also contributes to reporting, monitoring delegated PBM functions, and promoting member adherence, while delivering a high level of customer service.
The position does not exercise independent clinical judgment or make final adverse determinations, and all requests requiring clinical discretion are routed to a licensed pharmacist or an appropriate clinical reviewer.
Qualifications:
- Bachelor's degree in the healthcare field, or in business administration
- Actively registered with the Texas State Board of Pharmacy as a certified pharmacy technician
- 3+ years of experience with a Health Plan or PBM in related functions.
- Strong experience with prior drug authorization process in a Health Plan or PBM
- Microsoft Office (Word, Excel, Outlook, PowerPoint); Visio preferred.
- Strong attention to detail, problem-solving, and interpersonal skills
Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs.
Community is an Equal Opportunity Employer.
Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement.
To learn more, contact:
Viviana Elizondo, Talent Attraction Partner I
Viviana.Elizondo@CommunityHealthChoice.org
