Clinical - Pharmacy Coordinator 1 - 210120

Additional qualities to look for: Medicare/Quality experience preferred, Advanced Microsoft office experience preferred (Excel, Word, Teams, Outlook), Customer service Top 3 must-have hard skills stack-ranked by importance. Employee will conduct outbound outreach to members, providers, and pharmacies to support pharmacy quality initiatives focused on medication adherence, high-risk medication use, and appropriate therapy measures.

Job Profile Summary

Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.

Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.

For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.

For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.

For Centene Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.

Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process

Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines

Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns

Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team

Assist Provider Relations and various departments with educating providers on the health plan s pharmacy process

Assist with the pharmacy utilization review and reporting process

Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes

Assist with members inquiries related to the formulary process
Performs other duties as assigned

Complies with all policies and standards

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Position Purpose: Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program. Education/Experience: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. For Superior Health Plan: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred. License/Certificate: Current state s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date. For Arizona Complete Health: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. License/Certificate: Current Arizona Pharmacy Technician license. For Centene Pharmacy Services: High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users. License/Certificate: Current state's Pharmacy Technician license preferred. Responsibilities Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team Assist Provider Relations and various departments with educating providers on the health plan s pharmacy process Assist with the pharmacy utilization review and reporting process Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes Assist with members inquiries related to the formulary process Performs other duties as assigned Complies with all policies and standards
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		Execute targeted quality improvement efforts to strengthen Medicare Pharmacy STAR measure performance and achieve year-end goals. Surrounding Team: Diverse, collaborative, and supportive environment No additional upcoming hiring needs.
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			Employee will conduct outbound outreach to members, providers, and pharmacies to support pharmacy quality initiatives focused on medication adherence, high-risk medication use, and appropriate therapy measures. Employee will be evaluated on: # of calls made per day/week # of successful interventions Thorough follow-up and documentation Call audits
Candidate Requirements
Education/Certification	Required: High school diploma or equivalent				Preferred: N/A
Licensure	Required: N/A				Preferred: Pharmacy Technician license preferred
Years of experience required: N/A Disqualifiers: Poor communication/customer service skills (position will be outbound call based) Additional qualities to look for: Medicare/Quality experience preferred, Advanced Microsoft office experience preferred (Excel, Word, Teams, Outlook), Customer service
Top 3 must-have hard skills stack-ranked by importance			1	Pharmacy experience, preferably in a managed care or retail environment
			2	Excellent verbal and written communication skills
			3
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting
			Type of Interviews:			Teams
			Required Testing or Assessment (by Vendor):			N/A