Specialty Pharmacy Navigator, Per Diem (Pharmacy Tech)

Cape Cod Healthcare Inc.; Hyannis (MA); On-site; USD 45,000 - 65,000; Full time

Job summary

JobRx, Inc. in Massachusetts seeks a Specialty Pharmacy Navigator to manage the ongoing relationship between patients and specialty pharmacy services, ensuring medications are delivered timely and supported by comprehensive patient education.

The Navigator will interface with healthcare teams, assist with prior authorizations, eligibility checks, and coverage analyses, and help optimize the patient experience across the specialty pharmacy program.

Qualifications

• Massachusetts Pharmacy Tech License required.
• PTCB Certification or equivalent within 1 year of hire.
• Minimum one year of healthcare experience.
• Strong communication and interpersonal skills.
• Familiarity with specialty pharmacy resources.

Responsibilities

• Builds and maintains effective relationships with healthcare teams and patients.
• Navigates specialty pharmacy prescriptions from introduction to delivery.
• Coordinates with physicians, nurses, pharmacists to ensure timely medication delivery.
• Resolves insurance issues and educates patients about benefits and processes.
• Interacts with providers and clinic staff to answer questions about services, billing, and delivery.

Skills

Customer service

Communication

Team collaboration

Microsoft Office

Healthcare coordination

Problem solving

Diversity awareness

Education

Massachusetts Pharmacy Tech License

PTCB Certification

Job description

Purpose of Position

Under the general supervision of the Sr. Manager of Retail & Specialty Pharmacy/Director of Retail Pharmacy, the Specialty Pharmacy Navigator will assume primary responsibility for the ongoing relationship between the provider and specialty pharmacy services. The Specialty Pharmacy Navigator will direct specialty pharmacy claims in an efficient manner to provide the highest level of coordinated care to our patients.

Description

1. Establishes and maintains effective relationships with the healthcare team and patient. Exemplifies excellent customer service during interactions with patients, employees, providers and others to build the Specialty Pharmacy program.
2. Holds the primary responsibility of navigating specialty pharmacy prescriptions from the introduction to the patient to the delivery of the specialty medication.
3. Integrate with patients, physicians, nurses, pharmacists, and other health care professionals to ensure that assigned Specialty Pharmacy patient receives the medications he/she needs at the appropriate time.
4. Interface and problem solve, if needed, with the referring provider and/or clinic staff; monitors satisfaction of patients.
5. Represent on-site/off-site Specialty Pharmacy seamlessly, answer patient and provider staff questions about the service, insurance issues, deliveries, and any other related subject. Initiate call to pharmacist for intervention when appropriate.
6. Expedites the prescription filling process (entering patient demographics, allergies, insurance information); obtain benefit information, verify patient insurance eligibility and level of coverage; understand Medicare/Medicaid regulations and billing guidelines as they pertain to Specialty Pharmacy patient benefits; understand billing primary, secondary and tertiary insurance claims.
7. Process medication orders confirming that they are billed to all third parties correctly. Initiate and assist with the Prior Authorization and Patient Prescription Financial Assistance processes within the assigned therapy classes; resolve billing issues and obtain Prior Authorizations for medications when needed.
8. Work with Patient Financial Advocates regarding ongoing coverage levels/issues; provide education and training as necessary or instructed.
9. Establishes relationships with other specialty pharmacies to provide care out of network when appropriate.
10. Assist in marketing efforts to enhance business and increase revenue and patient retention by understanding Specialty Pharmacy business, trends, marketing materials and business expectations.
11. Assist Pharmacy Manager with tasks to improve processes to facilitate communications and service between patient, clinic and Specialty Pharmacy teams to ensure accurate and timely delivery of all medications.
12. Maintain patient education materials, collect data, run statistics and monitor productivity.
13. R etrieval of prescriptions from patients; data and prescription entry; prescription filling and packaging , general phone/customer service involving refills and resolving insurance issues; working the cash register
14. Works collaboratively with members of the healthcare multi-disciplinary team and communicates effectively with departmental staff and patient.
15. Performs other work related duties as reasonably requested/directed.

Qualifications

• Current Massachusetts Pharmacy Tech License
• Pharmacy Technician Certification Board (PTCB) Certification or equivalent within 1 year of hire
• Minimum one year of related healthcare experience
• Ability to develop effective working relationships with medical team
• Ability to communicate clearly and effectively in person, in writing or by phone
• Familiarity with Specialty Pharmacy resources preferred
• Familiarity and ability to work with diversity of cultural/socio-economic background
• Proficiency with computers and most commonly used Microsoft programs