Senior Pharmacy Benefits Specialist - St. Luke's Health Plan

Are you passionate about healthcare, problem-solving, and making an impact?

Do you thrive in dynamic environments where your expertise can truly make a difference for patients and providers? If so, we want you to join our team as a Senior Pharmacy Benefits Specialist!

As a Senior Pharmacy Benefits Specialist, you'll play a pivotal role in helping our members navigate complex pharmacy benefits management (PBM) challenges. Your deep understanding of pharmacy, insurance, and third-party issues will be crucial in resolving complex cases, working with providers and pharmacies, and ensuring our members receive the care they need. You’ll be working in a collaborative, supportive environment, helping both patients and healthcare professionals understand and access the medications they need.

What You'll Do

• Lead with expertise – Serve as the primary point of contact for escalated pharmacy concerns, tackling complex issues involving prior authorizations, step therapy, and denied claims.
• Be a trusted partner – Build and maintain collaborative relationships with pharmacies, providers, and members, acting as a bridge between all parties.
• Handle the tough cases – Review clinical documentation, analyze high-cost specialty medications, and ensure that patient care aligns with Health Plan cost containment strategies.
• Provide solutions – Resolve third-party payer questions, facilitate claim adjudications, and guide members and providers through copay assistance programs and insurance complexities.
• Be the go-to resource – As a subject matter expert (SME), help lead complex escalations, educate team members, and provide expert advice on navigating PBM issues.
• Mentor and lead – Serve as a mentor and role model to the Pharmacy Benefits team, helping to train and onboard new members while also preparing for and leading team meetings.
• Make an impact – Be a key player in ensuring that patients get timely access to their medications while driving cost-effective outcomes for the organization.

What You Bring

• Expertise in pharmacy benefits – In-depth knowledge of high-cost specialty medications, insurance plan design, pharmaceutical regulations, and third-party PBM systems.
• Problem-solving skills – Ability to think critically and navigate complex claims, insurance issues, and medication coverage scenarios.
• Communication mastery – Excellent interpersonal skills to build relationships with pharmacies, providers, and patients, and the ability to explain complicated insurance and medication issues clearly.
• Attention to detail – Capable of reviewing clinical documentation and ensuring compliance with drug regulations and therapeutic indications.
• Leadership skills – Experience in mentoring and supporting team members, and the ability to lead by example in providing exceptional service.
• Passion for healthcare – A commitment to improving the patient experience, ensuring members receive the care they need.

What We Offer

• Impactful work – You’ll be directly improving healthcare outcomes for our members and helping shape the future of pharmacy benefits management.
• Collaboration and growth – Work with a dedicated interdisciplinary team and continue your professional development through mentorship and ongoing education.
• Competitive benefits – We offer a robust benefits package including health insurance, retirement plan with company matching, paid time off, and more.

Ready to make a difference? If you are an experienced pharmacy benefits specialist with a passion for patient care, we want to hear from you. Apply now to join our team and help us transform the healthcare experience for those who need it most.