Pharmacy Quality Specialist

Job ID: Anticipated to close on Aug 28, 2026. Contract to Hire position based in Birmingham, AL.

About the role

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.

Requirements

• 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.

Skills

• 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.
• 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.

Pay

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.

Benefits

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 insurance
• 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)