Pharmacy Technician Analyst III
About The Position
This role oversees and administers pharmacy benefits for Sutter Health's value based pharmacy health plan services, including Sutter Health Plan HMO, serving as a pharmacy benefit and drug coverage subject matter expert responsible for reviewing pharmacy-related appeals and grievances by conducting clinical reviews under the supervision of a pharmacist, developing compliant administrative determinations, resolving escalated member issues, and educating members and internal stakeholders on appropriate use of benefits and resources. This position also supports workflow and desk-level-procedure development, maintenance, and optimization. Please Note: While this position is listed as hybrid, regular in-office attendance is required. Candidates should be prepared to commute to the office on a consistent basis to support team collaboration and business needs.
Requirements
- Graduate of an accredited pharmacy technician program.
- PHARMC-Certified Pharmacy Technician
- 2 years recent relevant experience
- Knowledge of data fields required by National Council for Prescription Drug Programs (NCPDP).
- Ability at running ad hoc reports from pharmacy claims data with strong PC skills including PowerPoint, Access, Outlook, Excel and Word.
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Health Care Reform, Business Code of Ethics and government regulated programs.
- Ability to work collaboratively, prioritize functions, problem solve, and anticipate upcoming issues for the executives.
Nice To Haves
- Prior Authorizations
- Appeals & Grievances
- Coverage Determinations
- Integrated Delivery Systems
- Managed Care PBM
Responsibilities
- Oversees and administers pharmacy benefits for Sutter Health's value based pharmacy health plan services, including Sutter Health Plan HMO
- Serves as a pharmacy benefit and drug coverage subject matter expert
- Reviews pharmacy-related appeals and grievances by conducting clinical reviews under the supervision of a pharmacist
- Develops compliant administrative determinations
- Resolves escalated member issues
- Educates members and internal stakeholders on appropriate use of benefits and resources
- Supports workflow and desk-level-procedure development, maintenance, and optimization
Benefits
- Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
- Eligible positions also include a comprehensive benefits package.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
11-50 employees
