Pharmacy Member Experience Specialist

Presbyterian is seeking a Pharmacy Member Experience SpecialistA Pharmacy Member Experience Specialist performs as a Presbyterian Pharmacy Services representative and as a Service Recovery Specialist and is responsible for providing customer service for members and providers for all PHP benefit plans. Specialists will ensure callers receive service excellence utilizing scripting, and critical thinking skills to assist with pharmacy questions or claims processing issues with regards to drugs and pharmaceuticals. The Pharmacy Member Experience Specialist will work to ensure members are highly satisfied with their prescription plan shown by improved Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, member satisfaction surveys and work to resolve any issues or concerns identified by our members. The emphasis is on providing patient-centered care to our members. They focus on improving the health outcomes of patients and providing access to medications and healthcare products in a more accessible and personalized way. Through this model, pharmacy technicians will provide individualized help, which may involve coordinating with other healthcare providers, and developing personalized plans to address each member¿s unique needs and ensure members are taking their medications correctly to get the most benefit out of them. The goal of this Pharmacy Specialist is to provide our members with an extraordinary healthcare experience. By focusing on the individual, offering enhanced communication and personalized services, this will help ensure members receive the best care possible, which leads to better health outcomes and satisfaction with their benefits.Medicare CAHPS: We need our members to feel that it was always easy to:*Use their prescription drug plan to get the medicines prescribed,*To fill a Rx at my local pharmacy,*To fill a prescription by mailTo rate their prescription drug plan a 10 out of 10.This is a Full Time position - Exempt: NoJob is based at Rev Hugh Cooper Admin CenterWork hours: Weekday Schedule Monday-FridayGED or High School diploma is required.Certified Pharmacy Technician-PTCB (CPHT-PTCB)Minimum of 1 year Retail Pharmacy experience preferredMinimum of 1-year Managed care customer service experience preferredDrug Information skillsAct as a subject matter expert to quickly and accurately resolve any calls or inquiries received by our Pharmacy Benefit Manager (PBM)Help members navigate formulary changes negatively impacted them or received a denial such as finding alternatives or initiating exceptionsFacilitate prescription refills between PCP, pharmacy, and health plan (keep member out of the middle)Help members find lower cost medications and help members avoid cost surprisesCoordinate finding medications when shortages occurFacilitate mail order set upMake outreach to new members that ask for us to contact them to help transfer prescriptionsMake outreach / accept transfers from service recovery team members that uncover a need around prescriptionsUtilize data from Mock surveys, new employer group onboarding, new Medicaid, and Medicare onboarding for members to identify members for targeted outreach.Utilize reject data to proactively outreach to those members and communicate benefits and formulary alternatives.Attend Medicare, Medicaid and Employer Group events to ensure proactive satisfaction with pharmacy benefits.Develop and maintain positive customer or partner relationships and acts as a member/patient advocate.*Appropriately routes any issue(s) that require additional internal review to the correctdepartment.Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements. Is ready to take calls at the schedule time and spends the appropriate amount of time taking calls throughout their shift to resolve pharmacy related issues.About Presbyterian Healthcare Services Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Created: 2025-11-24