Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Pharmacy Government Programs Coordinator

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Manager & Professional
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190OB Requisition #
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Support state sponsored , exchange, and Medicare Pharmacy programs.  Interface with internal and external partners to bring key deliverables across the finish line.  Maintain and enhance understanding of key compliance, regulatory, and organization requirements to support Medicaid, Exchange (ACA), and Medicare pharmacy programs.

Responsibilities:
  • Research and address issues and inquiries from internal and external stakeholders and partners.
  • Work closely with the PBM to fulfill Acumen, HPMS , NYDOH, and DFS deliverables like reporting, issue resolution, and audits.
  • Take ownership of the document management process which includes approval and implementation of marketing material and other provider  or member facing collateral.
  • Assist with quality assurance processes including but not limited to review of EOBs, transition letters, and new plan year testing activities.
  • Participates in disseminating Center for Medicare and Medicaid Services (CMS)  communications and in maintaining Compliance Monitoring Calendar.
  • Work closely with the pharmacy utilization management team to assure timely processing of IREs, reporting of IRE root cause and corrective action plans, and assist with implementing mitigation strategies.
  • Support tasks (review of data, pulling screenshots, etc.) related to audits.
  • AdHOC member outreach tasks to support the needs of the business.
  • Assist with documentation of policies and procedures.
Qualifications:
  • Bachelor’s Degree preferred but will consider HS GED with key experience
  • Pharmacy Technician certification preferred
  • Experience in a managed care setting 2-3 years required 
  • Medicare experience pertaining to the Part D benefit required
  • Individual must be detail oriented and able to move quickly from one task to the next required
  • Must be able to work in a team environment and embrace a collaborative approach required
  • Above average comprehension and written communication skills required
  • Understanding of Medicare Part D Manual preferred but not required preferred
  • Experience in a retail pharmacy setting may be helpful preferred
  • Timeline oriented and holds people accountable for deliverables required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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