Clinical Pharmacy Support Technician

CVS Health

2d•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. A Brief Overview Administers operational support to clinical pharmacy staff. Conducts outreach to providers, pharmacists, and members. Supports day-to-day processes, reviews data, and documents relevant interactions. Position Summary Primary responsibility is supporting Formulary Alternative Outreach Program for Medicare Part D. The Clinical Support Technician will support the operations of the Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This will include outreach calls to providers, pharmacists, and members. Responsibilities also include managing day-to-day processes, analyzing data, organizing and documenting all relevant interactions. Executes both routine and non-routine business support tasks for the Clinical Pharmacy Support area under limited supervision, referring deviations from standard practices to managers. Follows area protocols, standards, and policies to provide effective and timely support. Conducts reviews to ensure members receive the appropriate therapy as approved by the provider, determines therapy timelines, and determines claim appropriateness. Initiates education for providers and pharmacies on medication options, enhancements, and alternative therapy options for members. Communicates with pharmacies to verify claim information and reverse unnecessary claims. Ability to solve problems and make decisions independently

Requirements

4 or more years’ relevant experience
Valid Pharmacy Technician Certification (PTCB or ExCPT)
Working knowledge of Microsoft Outlook and Teams
Ability to interpret Pharmacy Claims data
Proficiency in computerized pharmacy systems and software applications
Previous provider/pharmacy outreach experience
Ability to perform duties with minimal supervision
Proficient knowledge of Brand/Generic drug names
High School Diploma or equivalent

Nice To Haves

Managed Care experience
Advanced knowledge of Microsoft Office applications
Understanding of medical and pharmacy terminology

Responsibilities

Responsible for making prescriber and or pharmacy outreach which includes reviewing formulary vs. non-formulary prescription claims.
Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate.
Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for members.
Responsible for prescriber outreach for specific Scoreable Action Item initiatives.
Work with team Pharmacist to investigate specific cases of overutilization including potential member outreach to ensure member has received products that have been dispensed under plan.
Maintain expert knowledge in most areas of pharmacy operations.
Ability to analyze and interpret various types of complex claim data under member plans.
Work with pharmacies to verify claims information and reverse unnecessary claims.
Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution.
Train, coach, and mentor new Clinical Support Technician Staff.