Pharmacy Program Specialist II

Built to Care. Driven to Improve. At Community Health Choice, we’re a nonprofit health plan dedicated to improving the health and well‑being of Texans, especially underserved communities. Our employees bring purpose into practice every day through compassion, collaboration, and a commitment to better outcomes. The Pharmacy Program Specialist II performs a criteria‑based review of pharmacy and medical benefit requests in accordance with established clinical guidelines, plan policies, and prior authorization protocols. The role requires a strong understanding of pharmacy and medical benefit drug coverage and adherence to regulatory timelines. The specialist also contributes to reporting, monitoring delegated PBM functions, and promoting member adherence, while delivering a high level of customer service. The position does not exercise independent clinical judgment or make final adverse determinations, and all requests requiring clinical discretion are routed to a licensed pharmacist or an appropriate clinical reviewer. Qualifications Bachelor's degree in the healthcare field, or in business administration Actively registered with the Texas State Board of Pharmacy as a certified pharmacy technician 3+ years of experience with a Health Plan or PBM in related functions. Strong experience with prior drug authorization process in a Health Plan or PBM Strong attention to detail, problem‑solving, and interpersonal skills Community employees benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs. Community is an Equal Opportunity Employer. It is the policy of Harris Health System to provide equal opportunity for all applicants for employment regardless of political affiliation, race, color, national origin, age, sex, religious creed or disability. Applicants may request any reasonable accommodation(s) to participate in the application process. #J-18808-Ljbffr Community Health Choice