Angela Drye

Work schedules/ Shift: The standard schedule is Monday – Friday 8am-5pm or 9am-6pm Mandatory attendance for start date and training must be okay with commute (first 30 days onsite) after 1 day onsite.   Contractors will not be paid for the upcoming CHC holidays as they will not be working. Please ensure they are aware of this prior to being submitted for review.   Upcoming Holidays to consider: -Memorial Day 5/25 and Juneteenth 6/19   Length of the assignment: 6 months (potential – temp – to – hire)   Location: 4888 Loop Central Dr # 600, Houston, TX 77081. This is a hybrid position. Interview details: Interview Schedules: Interview time slots:

• Monday, 3/30 9am-9:30am or 9:30am-10am
• Tuesday, 3/31 10:30am-11am or 1pm-2:30pm
• Wednesday, 4/1 1pm-3pm
• Thursday, 4/2 10am-11:30am

Based on feedback from our leadership team, they have asked that you do not modify or reformat the resumes upon submissions. . All interviews will be 30 min virtual Teams and scheduled by Healthcare Support. If we do proceed with a virtual format, we kindly ask that these meetings not be recorded. This will automatically disqualify the candidate. Minimum Qualifications BACHELORS DEGREE REQUIRED  healthcare or business admin. Registered with the Texas State Board of Pharmacy as a pharmacy technician and in good standing Prefer Minimum of 3 year experience with a health plan or PBM Strong experience with prior drug authorization process in a Health Plan or PBM Job Description The Pharmacy Program Specialist II performs 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 appropriate clinical reviewer. 70% Prior Authorization and Criteria-Based Review • Process prior authorization requests according to established criteria and protocol within defined turnaround time standards • Review pharmacy and medical benefit requests against established clinical criteria, plan policies, and authorization guidelines • Ensure completeness and accuracy of submitted documentation prior to escalation • Route requests that require clinical judgment or exception review to a licensed pharmacist or appropriate clinical reviewer • Identify and escalate incomplete, non-compliant, or exception-based requests to appropriate clinical reviewer 15% PBM Coordination and Workflow Support • Coordinate with PBM and internal departments to support authorization workflows • Track request status and ensure adherence to service level requirements • Communicate and effectuate request outcomes based on established determinations and protocol 10% Reporting and Monitoring Support • Support tracking of prior authorization volumes, turnaround times, and workflow performance • Assist in monitoring delegated functions and identifying operational variances. • Maintain documentation to support audit readiness and compliance requirements