What are the responsibilities and job description for the Pharmacy Specialist position at Priority Health?
This position follows a hybrid schedule with one onsite day per week on Thursdays.
Additional onsite days may be required periodically to support meetings, project work, or evolving team and business needs.
Are you passionate about ensuring pharmacy benefits are accurate, compliant, and working seamlessly behind the scenes? As a Pharmacy Specialist – primary focus on Part B and Part D determinations, Hospice, and ESRD - you’ll play a critical role in supporting pharmacy operations by partnering closely with the Pharmacy Benefit Managers (PBM), vendors, and internal teams to ensure benefit designs and systems are configured and administered correctly. This role is ideal for someone who thrives at the intersection of pharmacy operations, data integrity, and regulatory compliance—and who enjoys solving complex issues to support members, employer groups, and internal stakeholders alike.
Job Summary
Assists in developing and maintaining of the pharmacy operations systems. Direct interaction with Pharmacy Benefit Manager and other pharmacy vendors to ensure all systems and pharmacy benefits are administered accurately. Assist external and internal customers with pharmacy benefit and administration questions and issue resolution. Ensures governmental compliance by monitoring and auditing various vendors and processes.
Essential Functions
Required
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids
Department Name
Clinical Pharmacy Government Products - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. - 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Additional onsite days may be required periodically to support meetings, project work, or evolving team and business needs.
Are you passionate about ensuring pharmacy benefits are accurate, compliant, and working seamlessly behind the scenes? As a Pharmacy Specialist – primary focus on Part B and Part D determinations, Hospice, and ESRD - you’ll play a critical role in supporting pharmacy operations by partnering closely with the Pharmacy Benefit Managers (PBM), vendors, and internal teams to ensure benefit designs and systems are configured and administered correctly. This role is ideal for someone who thrives at the intersection of pharmacy operations, data integrity, and regulatory compliance—and who enjoys solving complex issues to support members, employer groups, and internal stakeholders alike.
Job Summary
Assists in developing and maintaining of the pharmacy operations systems. Direct interaction with Pharmacy Benefit Manager and other pharmacy vendors to ensure all systems and pharmacy benefits are administered accurately. Assist external and internal customers with pharmacy benefit and administration questions and issue resolution. Ensures governmental compliance by monitoring and auditing various vendors and processes.
Essential Functions
- Monitors extract exchanges with vendors and escalates concerns.
- Work with internal teams to create benefit grids and custom plan requests for system set up, and tests to ensure accurate configuration with the PBM
- Implements, audits and validates drug formulary changes and processes submissions to regulatory bodies. Coordinates member communication with Marketing.
- Reporting and analyzing data to ensure accuracy and compliance
- Participates and reports on behalf of the company in a variety of audits from governing bodies. Oversees PBM, vendors, and internal processes to ensure compliance.
- Communicates effectively with internal and external customers, avoiding jargon to ensure understanding
- Participates in projects to represent Pharmacy Operations
Required
- 2 years of related experience
- Bachelor's Degree or equivalent
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids
Department Name
Clinical Pharmacy Government Products - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. - 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.