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 expert support to the pharmacy department, serving as a subject matter expert for complex and escalated drug coverage and benefit-related issues. This role supports both external customers and internal stakeholders by ensuring smooth operations of pharmacy programs through thorough issue research, timely case resolution, and clear communication of outcomes. The specialist also supports the Medication Quality Team by coordinating Comprehensive Medication Reviews, proactively renewing expiring prior authorizations, conducting member outreach, and promoting medication adherence.

Responsibilities

• Act as a subject matter expert for complex and escalated drug coverage and benefit-related issues for internal stakeholders and external customers.
• Provide comprehensive support to the pharmacy department by addressing inquiries from members, pharmacies, provider offices, and employer group decision-makers.
• Conduct thorough research into drug coverage, benefit, and medication-related issues and take appropriate action to resolve cases in a timely manner according to established quality standards.
• Communicate case outcomes clearly and concisely through outreach to members, providers, and internal and external customers.
• Support the Medication Quality Team by scheduling Comprehensive Medication Reviews (CMRs) for eligible members.
• Proactively identify and renew expiring prior authorizations (PAs) to avoid interruptions in member therapy.
• Make member outreach calls to educate members about their medications and promote improved medication adherence.
• Collaborate with internal departments to ensure smooth operations of pharmacy programs and consistent quality of service.
• Maintain accurate documentation of cases, actions taken, and outcomes in accordance with organizational standards.
• Use Microsoft Office applications to manage data, track cases, prepare reports, and support pharmacy quality initiatives.

Essential Skills

• Current Pharmacy Technician License in good standing with the Alabama State Board of Pharmacy.
• Certified Pharmacy Technician (CPhT) credential from the Pharmacy Technician Certification Board (PTCB) or the National Healthcare Association.
• High School Diploma or GED.
• At least 5 years of experience in HMO, PPO, Medicare, pharmacy benefits management, retail pharmacy, long term care pharmacy, or hospital pharmacy.
• At least 5 years of experience as a pharmacy technician, with the majority of that time in a certified capacity.
• Strong knowledge of pharmacy operations, drug coverage, and pharmacy benefit structures across multiple care settings.
• Demonstrated excellent customer service skills with strong written and verbal communication abilities.
• Proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint.

Additional Skills & Qualifications

• Experience working in environments such as PBM, retail pharmacy, long term care pharmacy, hospital pharmacy, or managed care organizations.
• Ability to handle escalated and complex member and provider inquiries with professionalism and empathy.
• Strong problem-solving and analytical skills to research and resolve benefit and coverage issues.
• Ability to manage multiple cases and tasks simultaneously while meeting quality and timeliness standards.
• Comfort working in a non-retail pharmacy setting focused on quality, adherence, and member support.

Work Environment

This position begins as an onsite role with the potential to transition to a hybrid schedule once training is complete and performance expectations are met. The work is primarily desk-based, involving extensive use of a computer and telephone to research issues, manage cases, and conduct outreach to members and providers. The environment is structured and professional, with a focus on supporting pharmacy quality initiatives in a non-retail setting affiliated with a major Birmingham health system.

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 fully onsite position in Birmingham,AL.

This position is anticipated to close on Sep 8, 2026.

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 withoutregard to race, sex, age, color, religion, national origin, veteran status, disability,sexual orientation, gender identity, genetic information or any characteristic protectedby law.

If you would like to request a reasonable accommodation, such as the modification oradjustment 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 thecity and county of San Francisco, we will consider for employment qualified applicantswith arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as acondition of employment or continued employment. An employer who violates this lawshall 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 applicationsand qualifications, but final decisions are made by our hiring team. By applying, youacknowledge and agree that your application may be reviewed using AI tools.