Pharmacy Technician - Managed Care

Advanced Health•Coos Bay, OR

5d•Hybrid

About The Position

Responsible for the assessment and evaluation of requests for pharmaceutical products. Promotes quality, cost-effective care outcomes while ensuring the appropriate implementation of quality assurance, policies and procedures, Oregon Health Plan and other regulatory requirements.

Requirements

High School Diploma or equivalent required
Current Certified Oregon Pharmacy Technician License preferred, will consider applicant that has three to five year’s of related healthcare experience such as a medical assistant
Managed care or insurance setting experience a plus
Knowledge of diagnoses and appropriate care modalities
Knowledge of ICD, CPT and HCPCS codes, health insurance benefits and exclusions, and State and Federal mandates
Proficiency in the use of the organization’s transactional software
Adept at conducting research into project-related issues and products
Must be able to evaluate a situation and make appropriate decisions and work to control costs
Must have attention to detail and exceptional problem-solving skills for processing of complex pharmaceutical requests
Ability to work at a rapid pace, being involved in several duties at one time
Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
Proficient in Microsoft Office Suite and Windows Operating System (OS)
Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
Excellent people skills and friendly demeanor
Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
Organization skills
Ability to handle stress and sensitive situations effectively while projecting a professional attitude
Ability to communicate professionally, both conversing and written
Ability to work with diverse populations and interact with people of differing personalities and backgrounds
Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
Ability to organize and work in a sensitive manner with people from other cultures
Poised; maintains composure and sense of purpose
Must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner.
May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Must be able to work under conditions of frequent interruption and be able to stay on task.

Nice To Haves

Certified pharmacy technician
Strong attention to detail
Enjoy working in a fast-paced environment
Value being part of a team that makes a difference

Responsibilities

Coordinates, assists, and supports implementation of procedures and guidelines for the drug prior-authorization program.
Serves as a point of contact for providers and members in the Medical Management process by telephone or other correspondence.
Communicates prior-authorization criteria and discusses pharmacy benefit coverage inclusions/exclusions when required.
Provides drug usage history and other pertinent pharmacy benefit related computer reports for pharmacists and physician reviewers to assist in case specific reviews and drug evaluations.
Assists Pharmacy Director with drug utilization review programs or other assigned projects.
Researches and resolves physician inquiries and grievances.
Provides information to internal staff to resolve member inquiries and grievances, assists with formulary requests, medication questions, and claims history inquiries.
Participates in, evaluates, and maintains efficient workflow procedures in accordance with the Pharmacy Department’s goals and objectives.
Assists in ensuring members are effectively and efficiently managed through the Medical Management process as needs require.
Work with local pharmacies to coordinate care for members.
Within extension of authority, approves pharmaceutical services.
Creates worksheets and assists team members in the preparation of cases or in requesting additional information for care coordination, pre-service requests, and medical authorizations.
Participate in quality and organizational process improvement activities and teams when requested.
Assist audit preparation when focus is pharmacy related.
Ensure compliance with company policies and procedures as applicable to area(s) of responsibility.
Handle confidential information and materials appropriately and maintain a secure work area.
Other duties as assigned.
Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities.
Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner.
Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization.
Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations.
Recognize new developments and remain current in [position’s expertise] best practice standards and anticipate organizational modifications.
Advance personal knowledge base by pursuing continuing education to enhance professional competence.
Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards.
Represent organization at meetings and conferences as applicable.