Job Description: The position is remote to start and will transition to office when Client offices reopen.
Candidate must be local to Troy, MI
Candidate must be a Certified Pharmacy Technician. They need to be able to work independently and on a team as well as have working knowledge of medications not looking for hospital technicians but more so for those retail technicians.
Day to Day responsibilities include: review Medication Prior Authorizations faxing correspondence back and forth with physician office and must be able to multitask and answer phones speaking with physician offices, and working with pharmacies on rejected claims and some other internal depts as well. Contractor will be looking through medical charts looking for specific information and also looking at formularies and criteria, definitely need to be organized and need to know how to work in outlook and some basic excel be able to save / attach / send documents in outlook, be detail oriented, quick learner.
Must be able to work 40 hours. Dayshift looking to do probably a 9:30 to 6pm shift Monday thru Friday.
Summary: As part of the integrated Healthcare Services team, responsible for assisting pharmacies, physician offices and other entities in the efficient, timely and effective provision of pharmaceutical products and services to *** members. Utilizes specialized pharmacy knowledge and expertise and Client Policies to assess and determine appropriate disposition and drug coverage for prior approval requests and authorizations. Assesses pharmacy products and services for Client members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices. Enters on-line approvals or denials of requests per departmental approved guidelines/standards. Administers initial receipt and review of non-formulary or prior authorization required drugs against plan approved criteria. Performs miscellaneous drug pricing, member drug bills, specialty services as required. Solves Rx claim issues with pharmacy providers/provider representatives. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client Pharmacy Director and/or medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Expertise in Medical /pharmacy terminology, drug nomenclature, basic pharmacology, dosage calculations, units of measure, prescription filling techniques, prescription documentation requirements, pharmacy laws and regulations. Understanding of basic managed care pharmacy principles and insurance coverage issues. Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Clients policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers Required Education: High School Diploma or GED equivalent Completion of the Certified Pharmacy Technician Training Program Required Experience: Minimum of 0-2 years of experience as a Pharmacy Technician in the ambulatory, community, home infusion, long term care or managed care setting required. 0-2 years of healthcare industry experience (hospital, managed care, physician office, etc.). Required Licensure/Certification: Active license in good standing as a pharmacy technician with State Board of Pharmacy.
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