We are seeking a Pharmacy Benefits Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
The Pharmacy Benefits Coordinator plays an essential role in managing and optimizing pharmacy benefit programs. This position is responsible for coordinating with prescribers and targeted beneficiaries to ensure appropriate payment determination, evidence-based drug selection, and resolve medication-related problems. By maintaining accurate records and facilitating communication among stakeholders, the role helps improve member outcomes and control pharmacy-related expenses.
Minimum Qualifications:
- State of Florida Registered Pharmacy Technician License (RPT).
- Experience in managed care pharmacy.
- Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations.
Preferred Qualifications:
- Bachelor’s degree in Health Administration, Pharmacy, Business, or a related field.
- Knowledge of Medicare and Medicaid pharmacy benefit structures.
- Familiarity with data analysis tools and reporting software.
Responsibilities:
- Demonstrate commitment to Our Mission and model ILS Experience Standards of Excellence.
- Identify and resolve basic pharmacy claim rejections (e.g., incorrect billing codes, missing prior authorizations, coordination of benefits issues) with guidance from the pharmacist and respond to inquiries related to formulary status, benefit coverage, and pharmacy processes, ensuring clinical questions are escalated appropriately.
- Spot discrepancies in claims, documentation, or performance metrics and escalate concerns promptly.
- Assist members and providers with benefit‑related questions and support pharmacists and physicians by providing formulary information, benefit details, and documentation needed for coverage determinations while ensuring all clinical inquiries are routed to a pharmacist.
- Maintain accurate documentation in accordance with CMS Part D, Florida Medicaid, and internal health plan requirements.
- Support compliance activities, including policy updates, letter reviews, formulary updates, coverage changes, and audit preparation.
- Assist in preparing structured reports for CMS submissions, Medicaid reporting, quality initiatives, and internal reviews.
- Maintain organized files, data sources, and supporting documentation for audits and presentations.
- Collaborate with case management, utilization management, quality improvement, and other teams to support integrated care for members.
- Participate in workflow improvements and process enhancement initiatives.
- Conduct outreach to pharmacies, members and providers for DUR campaigns, MTM follow‑ups, adherence initiatives, and other quality programs.
- Perform all other duties as assigned.
Skills Required
- State of Florida Registered Pharmacy Technician License (RPT)
- Experience in managed care pharmacy
- Strong understanding of pharmacy benefit management, insurance claims processing, and healthcare regulations
- Bachelor's degree in Health Administration, Pharmacy, Business, or related field
- Knowledge of Medicare and Medicaid pharmacy benefit structures
- Familiarity with data analysis tools and reporting software
What We Do
Independent Living Systems, LLC, offers a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid and Dual-Eligible Market. Independent Living Systems has been an industry leader in managing home and community-based programs for over 16 years. Leveraging ILS’ award winning technology platform, ILS provides assistance beyond the clinical realm at every stage of care from hospitalization to the treatment of chronic illnesses to personalized care management including nutritional support. As one of the country’s leading providers of Nutritional Support Services and medically tailored meals, ILS provides nutrition counseling and home delivered meals for individuals transitioning from acute settings to the home as well as for those combatting the effects of one or more chronic diseases. In partnership with health plans, providers, hospitals, and pharmaceutical and medical device companies, ILS provides solutions aimed at improving health outcomes while rebalancing costs. ILS’ suite of products and services include: MLTSS - Managed Long-Term Services Supports Suite of solutions including assessments, care management, and coordination of home and community-based services, care planning, and back-office support CCM - Comprehensive Care Management A streamlined solution for ongoing care management and care optimization targeted towards special needs populations and special needs plans Meals and Nutrition One of the nation’s largest nutritional providers delivering consistent, high-quality therapeutic meals to elderly and at-risk populations TPA – Third Party Administration A fully integrated business and technology offering to support all administrative and financial reporting requirements of health plans and risk bearing entities MSO – Management Services Organization Population and provider-based interventions to address utilization and monitor unit costs of services For more information please contact us via email at [email protected].
