Coordinator, Pharmacy Operations

It’s Time For A Change…Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.What You’ll Be Doing:Your Future Evolves HereEvolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by Parity.org; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.Coordinator, Pharmacy OperationsThe RoleThe Evolent pharmacy team is looking for a highly motivated and energetic Coordinator, Pharmacy Operations to join the Pharmacy Services team. We are looking for team members that possess high-energy, a strong work ethic, integrity, who are kind and empathetic, have a sense of humor, and who enjoy working for a collaborative, team-oriented system.Responsibilities are varied as described below and dependent on business need. This position requires someone who is highly organized, detail-oriented, personable, and able to adapt to a dynamic working environment.General ResponsibilitiesNavigate across multiple systems to respond to questions from external and/or internal partners.

Consistently meet established productivity requirements, adherence to schedule and quality standards.

Always maintain confidentiality of protected patient medical information.

Ability to adapt to a changing environment including scheduling flexibility with the ability to work evening and weekend hours, as necessary.

Perform ad-hoc projects to support pharmacy operation initiatives.

Support the build out of medical utilization management service offerings (e.g., medical drug rebate analysis, searchable medical drug coverage database, site of care programs, outreach programs).

Support Specialty Copay card program (e.g., monitor authorizations, copays, trouble shoot issues, etc.).

Develop and maintain workflows and other training materials.

Utilization Management (UM) Responsibilities:Receive and review prescription prior authorization (PA) requests from providers and members via telephone, fax, email, and web-enabled submissions (e.g., electronic PA).

Providing general prior authorization information via telephone, fax or email to providers, members and/or Evolent client partners.

Perform outbound calls to provider and/or members to solicit information needed to process a prior authorization request, follow-up on PA requirements and/or provide consultation on the prior authorization program.

Perform outbound notifications to members and/or providers notifying them of prior authorization outcomes.

Review and approve, as applicable, member and provider inquiries for prior authorization requests based on established pharmacy guidelines and state and federal requirements.

Perform quality review of prior authorization requests to ensure adherence of established pharmacy guidelines and state and federal requirements.

Coordinate, compile and oversee the management of third-party external reviews for Medicare, Commercial and Medicaid lines of business.

Process patient submitted Direct Member Reimbursement (DMR) claims and support the appeal and grievance process related to pharmacy clinical determinations.

Pharmacy Call Center Responsibilities (as needed):Serve as direct member, pharmacy and/or provider contact for pharmacy benefit information, clinical determinations, and program information.

Coordinate and triage all pharmacy inquiries (i.e., phone, fax, correspondence, electronic media) and resolve all customer issues; ensuring accurate information is provided.

Function as liaison and subject matter expert related to client PBM systems and processes, specifically related to drug utilization management, drug prior authorization and pharmacy claim adjudication.

Obtain verbal prior authorization requests from member and/or prescribers while compiling and documenting accurate conversation details.

Assist in the review and management of override reporting to ensure effectuation standards are appropriately applied.

Assist in the operations of state defined Lock-In programs.

Clinical Outreach Responsibilities (as needed):Support Medication Therapy Management (MTM) and pharmacy outreach programs (e.g., refill reminders and adherence calls) through telephonic patient outreach, communication with provider offices and accurate documentation processes.

Support the scheduling and delivery of pharmacist-led consultations and follow-up of patients with complex medical conditions.

Assist clinical pharmacy programs including collection of medication history data and pharmacy care plan initiation under the guidance and direction of clinical pharmacists.

Required QualificationsAssociate’s or Bachelor’s degree

Excellent interpersonal communication skills, including exceptional listening and communication skills

Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and ability to learn multiple work-related software applications

Technical requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capabilities at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is committed to the safety and wellbeing of all its employees, partners, and patients. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.As we continue to evaluate re-opening our offices more fully and begin to have specific roles that will require face to face interaction with our providers and patients in client facilities or homes, all employees must be prepared to meet our vaccine requirements with or without accommodation at that time.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability statusTechnical requirements:Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.Compensation Range: The typical range of employees within the compensation grade of this position is $40,000 - $60,000. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.