Pharmacy Quality Specialist

Job Description

Job Description

Actively Hiring for Pharmacy Quality Specialist to join insurance company affiliated with major Birmingham Health Systems!

Job Description

The Pharmacy Quality Specialist provides critical support to the Pharmacy department by serving as a subject matter expert for complex and escalated drug coverage and pharmacy benefit issues. In this role, you will work closely with internal stakeholders and external customers, including members, pharmacies, provider offices, and employer group decision-makers, to ensure smooth operation of pharmacy programs. You will thoroughly research issues, resolve cases in accordance with established quality standards, and clearly communicate outcomes to all impacted parties. In addition, you will support the Medication Quality Team with activities that enhance medication safety, adherence, and overall member experience in a non-retail pharmacy environment.

Responsibilities

• Act as a subject matter expert for complex and escalated drug coverage and pharmacy benefit issues, providing guidance and resolution support to internal and external stakeholders.
• Provide direct support to internal departments and external customers, including members, pharmacies, provider offices, and employer group decision-makers, to ensure pharmacy programs operate smoothly.
• Thoroughly research pharmacy-related issues, analyze available information, and determine appropriate actions to resolve cases in a timely manner according to established quality standards.
• Communicate case outcomes clearly and concisely through written and verbal channels to members, providers, internal teams, and other impacted external customers.
• Collaborate with the Medication Quality Team to schedule Comprehensive Medication Reviews (CMRs) and ensure timely completion of these reviews.
• Proactively identify and work to renew expiring prior authorizations (PAs) to prevent interruptions in member medication therapy.
• Make member outreach calls to educate members about their medications, promote understanding of their drug coverage, and improve medication adherence.
• Support pharmacy quality initiatives by documenting activities, tracking case resolutions, and contributing to continuous improvement of pharmacy operations.
• Use Microsoft Office applications, including Word, Excel, Access, and PowerPoint, to prepare documentation, reports, and communications related to pharmacy quality activities.
• Demonstrate excellent customer service in all interactions by using professional, empathetic, and clear communication, both verbally and in writing.

Essential Skills

• Current Pharmacy Technician License in good standing with the Alabama State Board of Pharmacy.
• CPhT (Certified Pharmacy Technician) credential from the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association.
• At least 5 years of experience in HMO, PPO, Medicare, pharmacy benefits management, retail pharmacy, long-term care pharmacy, or hospital pharmacy.
• Experience as a pharmacy technician, with at least 5 years in the role and the majority of that time spent as a certified pharmacy technician.
• Strong understanding of drug coverage, pharmacy benefits, and prior authorization processes across various healthcare settings.
• Demonstrated ability to research complex pharmacy and benefit-related issues and resolve them according to quality and timeliness standards.
• Excellent customer service skills with the ability to communicate clearly and professionally through both written and verbal communication.
• Proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint.
• Ability to manage multiple cases or tasks simultaneously while maintaining accuracy and attention to detail.
• Strong problem-solving and critical-thinking skills, especially in a pharmacy or healthcare benefits environment.

Additional Skills & Qualifications

• High School Diploma or GED.
• More than 5 years of experience in HMO, PPO, Medicare, pharmacy benefits management, retail pharmacy, long-term care pharmacy, or hospital pharmacy is ideal.
• Experience working in a pharmacy benefits management (PBM) setting or similar environment.
• Experience in non-retail pharmacy roles, such as health system or managed care settings.
• Comfort working with members, providers, pharmacies, and employer groups by phone and electronically.
• Ability to contribute to medication adherence and quality initiatives, including Comprehensive Medication Reviews (CMRs) and prior authorization renewals.

Work Environment

This position begins as an onsite role and may transition to a hybrid schedule once you are fully up to speed and meeting performance expectations. The work is primarily desk-based, with most tasks performed on a computer and over the phone in an office setting. You will work in a non-retail environment affiliated with a major health system in the Birmingham area, focusing on pharmacy quality and benefits rather than direct dispensing. The role involves regular use of Microsoft Office applications and internal systems to manage cases, document activities, and communicate with members and stakeholders.

This is a Contract to Hire position based out of Birmingham, AL.

The pay range for this position is $23.00 - $24.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

This is a Contract to Hire position based out of Birmingham, AL.

This position is anticipated to close on Oct 29, 2026.

This is a fully onsite position in Birmingham,AL.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on ziprecruiter.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.