Pharmacy Programs Specialist
At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most.
The Clinical Pharmacy team is an innovative team that utilizes a member-centric approach to provide comprehensive medication management services. The Pharmacy Programs Specialist will work to support Medicare quality metrics, medication management initiatives, and maintain Centers for Medicare and Medicaid Services compliance standards.
In this role, you would perform validation of claim adjudication ensuring appropriate access to care and support telephonic outreach for plan members, providers and other healthcare professionals. In addition, document activity and maintain electronic medical records while providing the highest quality healthcare and service to plan members and other internal and external partners.
As a Pharmacy Programs Specialist you will:
- Create, manage, and respond to cases and/or escalate to Clinical Pharmacists on the Team.
- Contribute to i
