Pharmacy Benefits Coordinator

Pharmacy Benefits Coordinator We are seeking a Pharmacy Benefits Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. The Pharmacy Benefits Coordinator plays a critical role in managing and optimizing pharmacy benefit programs. This position is responsible for coordinating with prescribers and targeted beneficiaries to ensure appropriate payment determination, evidence-based drug selection, and resolve medication-related problems. By maintaining accurate records and facilitating communication among stakeholders, the role helps improve patient outcomes and control pharmacy-related expenses. Minimum Qualifications: State of Florida Registered Pharmacy Technician License (RPT) required. Experience in managed care pharmacy required. Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations. Preferred Qualifications: Bachelor's degree in Health Administration, Pharmacy, Business, or a related field. Knowledge of Medicare, Medicaid, and commercial insurance pharmacy benefit structures. Familiarity with data analysis tools and reporting software. Responsibilities: Engage in drug utilization review (DUR) by supporting letter campaigns, and telephonic outreach to members/providers. Maintain accurate documentation and records related to pharmacy benefits administration and communications. Monitor medication therapy management (MTM) services through prescriber follow-up and collaborations with other departments. Document and record oversight/activities in appropriate databases/software to ensure compliance with CMS and Florida Medicaid requirements. Consult with pharmacists and/or physicians regarding the use of medications and advise of appropriate formulary alternatives when requested. Respond to inquiries from other departments, physicians, and members related to formulary and prescription benefits. Refer all prescribers (MD, DO, APRN etc.) and customer calls related to medical questions to the Pharmacist.

Created: 2026-03-13