Pharmacy Care Coordinator

1199SEIU Benefit and Pension Funds; New York (NY); Hybrid; USD 37,000 - 107,000; Full time

Job summary

An established industry player is seeking a Pharmacy Care Coordinator to serve as a vital link between members and healthcare providers. This role involves managing prescription inquiries, ensuring compliance with regulations, and maintaining accurate benefit information. The ideal candidate will have a strong background in healthcare, excellent communication skills, and a passion for helping others. Join a dynamic team where your contributions directly impact the well-being of community members. This is an exciting opportunity to grow in a supportive environment while making a difference in people's lives.

Qualifications

• Minimum of one year experience in a healthcare setting required.
• Excellent knowledge of pharmacy and medical drug benefits.

Responsibilities

• Act as a liaison between members, providers, and pharmacies.
• Monitor and respond to escalated Rx benefit issues.

Skills

Bilingual language skills

Knowledge of pharmacy benefits

Customer service skills

Education

Associate’s Degree

Bachelor’s Degree

Pharmacy Technician Certification (CPhT)

Tools

Document Management System (DMS)

Vitech (V3)

QNXT

Job description

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• Act as a clinical and operational liaison of the Fund’s Rx benefit between 1199SEIU Benefit Fund members, providers, Utilization Management (UM)vendors, and pharmacies
• Access Fund’s UM vendor system in the Medical Benefit Drug Management Program to access and download report of medical drug UM cases
• Access Fund’s UM vendor system in the Medical Oncology Program to access and download provider, member, or facility site UM letters of medical oncology cases
• Access the Fund’s PBM system to access prescription drug and appeals information
• Utilize the Document Management System (DMS) Rx module to prepare, organize and maintain prescription drug inquiries received by fax from providers or members or other Fund Departments
• Monitor, screen and respond to incoming emails from Fund Departments to resolve escalated Rx benefit issues by close of business day
• Prepare Rx utilization forms in the DMS module and gather clinical documents by accessing UM vendor systems and researching past clinical authorizations
• Prepare physician UM benefit determination letters and appeal communications of prescription drug inquiries
• Fax provider communications of prescription drug clinical reviews through a secure method that is HIPAA compliant
• Verify member eligibility status and eligibility class in Vitech (V3), where applicable
• Enter notes in claims processing system (QNXT) of prescription drug inquiries, provider inquiries, and appeals
• Post Bulletin Board notices and contribute to BeneFAQs topics related to the Rx benefit
• Assist in maintaining the accuracy of the drug benefit content of the Fund’s website by working with Digital Communications
• Perform special projects and assignments as directed by management
  
  

Requisition #:

6995

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Non-Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Non-Exempt

Responsibilities

• Act as a clinical and operational liaison of the Fund’s Rx benefit between 1199SEIU Benefit Fund members, providers, Utilization Management (UM)vendors, and pharmacies
• Access Fund’s UM vendor system in the Medical Benefit Drug Management Program to access and download report of medical drug UM cases
• Access Fund’s UM vendor system in the Medical Oncology Program to access and download provider, member, or facility site UM letters of medical oncology cases
• Access the Fund’s PBM system to access prescription drug and appeals information
• Utilize the Document Management System (DMS) Rx module to prepare, organize and maintain prescription drug inquiries received by fax from providers or members or other Fund Departments
• Monitor, screen and respond to incoming emails from Fund Departments to resolve escalated Rx benefit issues by close of business day
• Prepare Rx utilization forms in the DMS module and gather clinical documents by accessing UM vendor systems and researching past clinical authorizations
• Prepare physician UM benefit determination letters and appeal communications of prescription drug inquiries
• Fax provider communications of prescription drug clinical reviews through a secure method that is HIPAA compliant
• Verify member eligibility status and eligibility class in Vitech (V3), where applicable
• Enter notes in claims processing system (QNXT) of prescription drug inquiries, provider inquiries, and appeals
• Post Bulletin Board notices and contribute to BeneFAQs topics related to the Rx benefit
• Assist in maintaining the accuracy of the drug benefit content of the Fund’s website by working with Digital Communications
• Perform special projects and assignments as directed by management
  
  

Qualifications

• Associate’s Degree required. Bachelor’s Degree or Pharmacy Technician Certification (CPhT) preferred
• Minimum of one (1) years prior work experience in a health care setting such as: retail or mail order pharmacy, physician’s office, outpatient medical facility, Pharmacy Benefits Manager ( PBM) DME supplier or Prior Authorization (PA) Call Center is required
• Bilingual language skills are a plus
• Excellent knowledge of the Fund pharmacy and medical drug benefits, eligibility rules and regulations

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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