Pharmacy Benefits Strategist

Community Health Group; Chula Vista (CA); On-site; USD 42,000 - 54,000; Full time

Job summary

Community Health Group in California is seeking a Pharmacy Technician to assist in delivering pharmacy services and processing prior authorization requests.

The role interfaces with PBMs, providers, and the customer service team; requires HS diploma, valid Tech license, and 2 years retail/pharmacy or MCO experience; bilingual English/Spanish preferred.

You will maintain records, participate in HEDIS, and support reporting while ensuring confidentiality and adherence to CHG policies.

Qualifications

• Two years’ experience in retail pharmacy.
• Minimum two years’ experience in managed care pharmacy or pharmacy benefits management.
• Bilingual English/Spanish highly preferred.
• Ability to operate a personal computer, fax, photocopier, calculator.
• Knowledge of word processing and spreadsheets required.
• Strong verbal, written, analytical and interpersonal skills.
• Ability to organize and prioritize work effectively; detail oriented; apply established policies procedures and guidelines for problem-solving and decision making.
• Self-directed.

Responsibilities

• Interfaces with CHG’s Customer Service Department, PBM and providers and pharmacies to ensure the provision of Plan’s pharmacy benefits and services in accordance with plan documents and standards.
• Assists CHG’s Customer Service Department, pharmacies, physicians, case managers, and PBM in addressing members’ medication-related needs on a case by case basis.
• Interfaces with PBM in the prior authorization process; processes all prior authorization requests in established timeframes; gathers appropriate clinical information necessary; forwards requests to appropriate clinical reviewers; maintains all records according to established standards.
• Participates in HEDIS-related activities and initiatives and in disease management and outcome studies as required.
• Assists in the preparation of reports by collecting and documenting information and provides written reports to pharmacy management.
• Monitors and documents core department activities according to internal procedures and reports any concerns without delay.
• Maintains customer confidence and protects operations by keeping information confidential.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Contributes to the team effort by accomplishing related results as needed.
• Maintains product and company reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.
• Other duties as assigned.
• Maintain valid Pharmacy Tech license.

Skills

PC skills

Word processing

Spreadsheets

Verbal communication

Interpersonal skills

Bilingual English/Spanish

Organizational skills

Education

High school diploma or GED

Pharmacy Tech license

Vocational training

Job description

Community Health Group in California is seeking a Pharmacy Technician to assist in delivering pharmacy services and processing prior authorization requests.

The role interfaces with PBMs, providers, and the customer service team; requires HS diploma, valid Tech license, and 2 years retail/pharmacy or MCO experience; bilingual English/Spanish preferred.

You will maintain records, participate in HEDIS, and support reporting while ensuring confidentiality and adherence to CHG policies.