Certified Pharmacy Technician - Jefferson Health Plan

Pharmacy Hotline Representative

Works under general supervision and answers calls from physician and pharmacy providers through pharmacy hotline. Assist in administering prior authorizations according to established guidelines and assists Clinical Pharmacists in case review process. Actively participate in physician education and outreach program and perform claims analysis for drug utilization review (DUR), fraud, abuse, and over-utilization.

Job Duties

• Able to work in a constant state of alertness and safe manner
• Assist department in reaching call center goals based on standards of productivity (percent of calls answered within 30 seconds, percent of abandoned calls)
• Assist department in reaching call center goals based on standards of quality (providing accurate information to physicians and pharmacies)
• Maintain knowledge of different pharmacy benefit packages under Medicaid and Medicare to be communicated to providers and other departments
• Assist Clinical Pharmacists in responding to physician and pharmacy providers' telephone calls, to provide safe and effective formulary alternatives, resolve processing errors (i.e. eligibility, plans limits exceeded, national drug code (NDC) not covered, refill too soon, etc.).
• Assist Clinical Pharmacists in reviewing clinical cases including researching previous medication history, obtaining additional information as it pertains to the case, notifying physician's office of approval and/or denial of prior authorization request, generating letters for approved medication requests, and expedite prior authorization requests.
• Interact with other departments including Member Relations, Special Needs Unit, Complaints and Grievances, Disease Management, and Utilization Management; assisting in resolving pharmacy issues.
• Conduct clinical DUR on pharmacy claims and make recommendations for recipient restriction program.
• Provide ideas and suggestions to help improve quality and flow of pharmacy department.
• May perform other duties as assigned.

Minimum Qualifications

• High School Diploma/GED
• 1 year of experience in pharmacy.
• Familiar with a managed care and delegated pharmacy services
• Excellent written and oral communication skills
• Self-motivated and a team player.
• Proficient in Excel and relational databases such as MHS, CIC, DST, Macess
• CPhT - Certified Pharmacy Technician - Pharmacy Technician Certification Board

Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America