Posted in Other 2 days ago.
SUMMARY
This position is responsible for supporting clinical and operational processes for clinical pharmacy Star measures within Medicare. The Senior Pharmacy Technician will execute member interventions to resolve any barriers preventing a member from becoming adherent to their medication regimen. This position will also be responsible for making and/or triaging calls to appropriate staff based on the complexity of the call. The Pharmacy Technician will interact with pharmacists, interns, pharmacy students and analysts to support current programs and assist in quality reviews to ensure continued process improvement.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.
1. Monitors and liaises toll free call center, handle in-coming and make outgoing member, provider and pharmacy calls.
2. Assist leadership by investigating challenges and issues to determine root cause and recommend innovative solutions to bring resolution.
3. Independently address and resolve adherence barriers at the member, provider or pharmacy, including documenting activity and outcome
4. Become a subject matter expert in all benefit designs and formularies to resolve issues rea time.
5. Create branch-tree logic for resolving claims issues and member complaints.
6. Document processes, creates FAQ sheets, training materials and trains new hires.
7. Assist in the research, analysis, identification, and evaluation quality and data from assigned problems to evaluate existing an potential trends and issues.
8. Assist in monitoring program initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.
9. Assist in development of plans, reports, papers, and creation of other documents to ensure process improvements and work efficiencies.
EDUCATION AND EXPERIENCE
Relevant combination of education and experience may be considered in lieu of degree.
1. Associate degree required.
2. Active unrestricted Pharmacy Technician License or Pharmacy Technician Certification (PTCB) required.
3. At least three (3) years' experience in retail, hospital or managed care pharmacy preferred.
4. Knowledge of prescription drug names and therapeutic classes.
5. Experience with Medicare Part D prescription benefits is preferred.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 2 Last Updated: 11/21/2022
OTHER SKILLS AND ABILITIES
1. Demonstrated leadership and project management abilities.
2. Ability to make competent, independent decisions.
3. Ability and proficiency in the use of computers and Company standard software specific to position.
4. Strong customer service and phone skills.
5. Strong verbal and written communication skills to handle complex situations.
6. Project management skills.
7. Strong ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.
8. Knowledge of pharmacy claims processing; working knowledge of Medicare Part D is preferred.
9. Understanding of formularies and utilization management edits.
10. Ability to effectively present process improvements, root cause analysis or solutions in one-on-one or small staff meetings.
ADDITIONAL INFORMATION
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $49,900 and $83,600.
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