Find & Apply For Pharmacy Technician Jobs in Spring Hill, Florida

Position Summary The Pharmacy Technician & Quality Performance Coordinator supports Access Health Care Physicians' Medicare Advantage, ACO, and value‑based care initiatives by ensuring accurate documentation, quality measure compliance, and effective coordination with PBMs, clinical offices, and internal departments. This role does not perform any medication dispensing . Instead, it leverages the candidate's pharmacy background to support formulary oversight, coverage determinations, quality reporting, HEDIS metrics, and field‑based practice support . Essential Duties & Responsibilities Coverage Determinations & PBM Coordination Follow up with members, providers, and PBMs to obtain or verify information for coverage determination cases. Document case details including receipt dates, investigation notes, communications, and resolutions in internal and PBM systems to maintain CMS and NCQA audit readiness. Ensure prescription coverage determinations align with benefit design, formulary rules, tier exceptions, quantity limits, and clinical appropriateness. Collaborate with PBMs on clinical initiatives that improve member outcomes and support value‑based performance. Quality, HEDIS & ACO Performance Support Monitor, audit, and validate clinical documentation for compliance with

HEDIS , ACO

, and Medicare Advantage quality measures. Work with clinical offices to capture supportive data and close care gaps. Assist with quality‑related patient events and outreach activities. Enter compliant documentation into practice software systems with accuracy and timeliness. Report issues, trends, and quality gaps to management. Reporting & Metrics Generate, interpret, and distribute performance reports related to HEDIS, MRA, quality measures, and PBM case activity. Support physicians and clinical teams by explaining performance metrics and identifying opportunities for improvement. Maintain productivity, compliance, and timeliness standards for CMS and NCQA. Field‑Based Office Support (25-50% Travel) Conduct regular on‑site visits to assigned offices within approximately 100 miles. Provide guidance on documentation accuracy, quality workflows, and Medicare Advantage requirements. Assist with onboarding and training for newly assigned offices. Occasionally travel overnight for meetings, audits, or quality initiatives. General Responsibilities Respond to inquiries from Member Services, Appeals & Grievances, and internal departments regarding prescription drug program issues. Maintain HIPAA compliance while auditing sensitive medical information. Perform additional duties and projects as assigned. Qualifications Education & Experience Certified Pharmacy Technician (CPhT) or equivalent experience preferred . Bachelor's degree or equivalent experience preferred . 4-6 years of progressive experience in PBM, Part D, Pharmacy Operations, Managed Care, or Quality Programs preferred . 1-2 years of experience in a healthcare or medical office setting preferred . Skills & Competencies Strong understanding of formulary management, benefit design, and coverage determination processes. Basic knowledge of medical terminology and quality measure concepts. Proficient in Microsoft Excel, Word, PowerPoint, and web‑based systems. Ability to read, interpret, and communicate clinical and technical information. Strong verbal and written communication skills. Time management, organization, and ability to meet productivity expectations. Ability to audit documentation with accuracy and attention to detail. Physical Demands Regularly required to sit, talk, and hear. Occasionally lift and/or move up to 10 pounds. Requires close and distance vision and ability to adjust focus. Work Environment Office‑based and field‑based environments. Generally quiet but may vary depending on practice activity.

Job Type:

Full-time Pay:

$16.00 - $19.00 per hour

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Pharmacy technician experience: 1 year (Required)

License/Certification:

Pharmacy Technician Certification (Required)

Work Location:

In person