Pharmacy Outreach Coordinator

Univera Healthcare•Buffalo, NY

9d•Hybrid

About The Position

The Pharmacy Outreach Coordinator provides administrative support to pharmacy programs designed to generate revenue and lower pharmacy spend for our Health Plan and out of area clients, as well as lower out-of-pocket cost and improve quality metrics for our program members. The Pharmacy Outreach Coordinator performs functions as permitted by law including outreach to providers, members and/or pharmacies focusing on therapeutic interchange strategies and other cost savings or quality improvement programs. The incumbent closely with clinical and analytic staff dedicated to these programs.

Requirements

High school education required with a minimum of two years’ experience in health related field.
Pharmacy Technician certification (CPhT) strongly preferred.
Experience working in a doctor’s office, hospital, infusion center, pharmacy, or customer service strongly preferred.
Basic understanding of drug classes and therapeutic interchange as displayed on the drug formulary or described in the drug policies.
Awareness of prescription and medical benefits as it applies to the utilization review process and drug formulary is desired but not required.
Remain current on necessary clinical information required for high quality outreach encounters and to effectively reconcile interventions.
Strong communication skills are necessary including written, verbal and telephone.
Possess a high degree of professionalism, strong work ethic and the ability to maintain a positive attitude when dealing with internal and external customers.
Ability to be conscientious, efficient and accurate handling large amounts of information via spreadsheet or database.
Must possess strong customer service orientation and the ability to interface effectively with internal and external customers.
Capable of working independently and applying problem solving and analytical abilities.
Minimum of 2-3 years' experience working with a health plan organization.
Basic understanding of medical terminology and ability to apply this to individual cases and conversations.
Clear understanding of prescription and medical drug benefits and the impact of benefit design on program recommendations.
Demonstrated proficiency with Excel, other company platforms and databases.
Demonstrated ability to navigate the healthcare system including understanding the relationship with vendors and healthcare facilities.
Strong ability to develop and refine techniques and skill to respond to providers, pharmacies and members.
Demonstrated capacity and ability to mentor/train less experienced staff.

Nice To Haves

Pharmacy Technician certification (CPhT) strongly preferred.
Experience working in a doctor’s office, hospital, infusion center, pharmacy, or customer service strongly preferred.
Awareness of prescription and medical benefits as it applies to the utilization review process and drug formulary is desired but not required.

Responsibilities

Performs administrative tasks which support pharmacy programs and projects.
Perform provider, member, and pharmacy outreach related to our clinical programs.
Analyze financial progress reports and prioritize tasks to meet stakeholder expectations.
Serves as an outpatient medication access specialist to serve members locally and outside of our direct service area.
Perform routine quality checks on relevant system applications and functions.
Provides recommendations on how information should be documented, tracked, and measured based on existing processes.
Collaborates with key staff members to identify process inefficiencies, recommendation success rates, and systematic failures.
Efficiently and reliably adopts new processes and procedure changes as appropriate.
Provide weekly updates to department supervisor related to work assignments and response to provider outreach.
Initial level assessment of claims files/data extractions to identify appropriate cases for outreach.
Prepares and assist in handling patient and provider outreach related to targeted programs.
Produces statistics on a predetermined frequency regarding all attempted outreach and inbound inquires in an appropriate manner.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Keeps leadership informed of successes, challenges and barriers of the programs when they arise and provides recommendations on logical and effective solutions.
Offers process improvement suggestions and participates in the solutions of more complex issues/activities.
Displays leadership and serves as a positive role model to others in the department.
Mentors junior staff & assists with coaching whenever necessary.
Manage weekly and monthly scheduling of coordinators to ensure all required elements of the program are completed by established due dates and directing peers appropriately to increase probability that stakeholder expectations are successfully met.
Provides consistent positive results with prescriber outreach and conversion rates.
Supports and communicates procedural changes to enhance program results and improve payer/provider relations and minimize program abrasion with providers and members.
Develop appropriate DLPs, speaking points and educational tools to further support coordinator staff.
Lead training efforts for new coordinators on program goals, program policy and procedure, and platform navigation.
Facilitate communication between coordinators, clinical pharmacists, and project management.