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  • Farmington, CT

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Pharmacy Technician (Temporary)

ConnectiCare • Farmington, CT

Posted 1 month ago

Job Snapshot

Seasonal/Temp
Other Great Industries
Skilled Labor - Trades

Job Description

ConnectiCare is a leading health plan in the state of Connecticut.  A local company for more than 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. By striving to make it easy for members to get the care they need, ConnectiCare leads the individual market in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance. ConnectiCare is a subsidiary of EmblemHealth.

 
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.

Summary of Job:  Performs intake, evaluates and processes pharmacy prior authorization requests to support the efficient and accurate administration of the prescription drug benefit and management of pharmacy expenses. Communicates decision to physicians, physician’s office staff, medical management staff, and/or pharmacies. Escalates requests to Pharmacist when request requires extensive clinical review or denial. Serves as a training resource, mentor, and coach to others, within the department.

 Responsibilities:

  • Maintain comprehensive knowledge of CCI prescription benefits, utilization management criteria, and process.
  • Responsible for retrieval and first review of requests for utilization managements.
  • Validates information in requests and communicates with requesting practitioner to clarify information as necessary.
  • Reviews formulary and criteria, as appropriate, to assess if medication requests meet coverage criteria.
  • Approve prior authorization requests under supervision of a clinical pharmacist for a handful of drugs that meet predetermined criteria. All other cases need to be referred to a clinical pharmacist for review.
  • Responsible for data entry of authorizations and additional documentation of requests in designated pharmacy systems.
  • Notifies requesting practitioner, member, and internal key stakeholders of authorization disposition per departmental and regulatory guidelines.
  • Responsible for tracking information being requested and assuring that the all required time frames are met.
  • Assists with filing appropriate information into the member file as directed.
  • Participates in ensuring the accurate administration of retail, specialty drug and home delivery benefits.
  • Responds to telephone inquiries from practitioners, members, pharmacies and ConnectiCare employees regarding medication requests, triaging calls that require clinical intervention, regarding pharmacy related inquires
  • Collaborates with Call Center and Pharmacy Operations, to assisting in problem solving resolution.
  • Researches questions from the Pharmacy Hot Box, Pharmacy Issue, and Pharmacy Appeals basket.
  • Intake and process manual pharmacy paper claims from member submissions.
  • Being on-call or working flexible hours may be required on a rotational basis.
  • All other duties as requested by department management.


Qualifications:

  • Pharmacy Technician Certification Required
  • Associates or Bachelor's degree preferred or an equivalent combination of training and experience
  • At least 2 years of pharmacy related experience
  • At least 2 years of call center customer service experience
  • Claim system knowledge with ability to analyze pharmacy claims
  • Knowledge of Medicare Part D
  • Excellent communication skills with employees, practitioners and members regarding verification and explanation of pharmacy benefits
  • Excellent organizational, prioritization and time management skills
  • Detail oriented with strong analytical, problem solving and follow up skills
  • Work independently within a team environment with/little direct supervision
  • Demonstrated proficiency using personal computers, MS Office software including Word, Excel, and Access required
  • Ability to work in a high pace, stress environment
 ConnectiCare is an equal opportunity employer. M/F/D/VConnectiCare is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.
Job ID: 19-071T
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