Pharmacy Coordinator 1 - 210120

IMCS Group; California; Presencial; USD 42.000 - 64.000; Jornada completa

Descripción de la vacante

IMCS Group is seeking a Pharmacy Technician to support health plan pharmacy operations in California. The role focuses on prior authorization, formulary management, and responding to provider/pharmacy inquiries with accuracy and compliance.

The candidate should have 3+ years of pharmacy experience in a managed care setting, with Medicare/Medicaid exposure and a valid PTCB certification or ability to obtain within 30 days.

Formación

• 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.
• Current state's Pharmacy Technician license and PTCB or ability to obtain within 30 days.

Responsabilidades

• 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

Conocimientos

Pharmacy experience

Call center

Multi-line phone system

Educación

High school diploma

PTCB certification

Herramientas

Analysis tools

Descripción del empleo

Description: 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 *** 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

Custom Fields

Name: Field Worker

Value: No

Name: If this request is replacing a previously canceled request, please provide the original Request ID

Value: None

Name: Which Health Plan, programs or functions will this work support?

Value: *** Pharmacy Services

Name: Shortlisting Date

Value: None