Pharmacy Technician - Case Management- Oncology

Key Accounts Case Manager

In general, the key accounts case manager will be responsible for the following tasks:

i. Review and interpret medical prescriptions to ensure appropriate therapies.

ii. Review medical policies of medications to ensure they meet requirements and can be billed.

iii. Transcribe prescription data in preparation for pharmacist verification.

iv. Communicate with all new patients informing them about preauthorization requirements for the prescription and welcoming them to Specialized Pharmacy Alivia.

v. Gather all necessary information and documents to support the approval request to the medical plan or PBM.

vi. Communicate with insurance companies or other payers to complete prior authorization requirements.

vii. Answer incoming pharmacy calls with excellent customer service standards and follow up on pending tasks (internal or external).

viii. Meet production standards set by management, either quantitatively or qualitatively.

ix. Obtain patient medication list for DUR investigation.

x. Issue and review claims for prescription drug insurance to be delivered to patients and providers.

xi. Refer to the Patient Assistance Program department in cases where the patient cannot pay deductibles.

xii. Develop relationships and act as a liaison with doctors, patients, infusion centers, manufacturers, and patient assistance programs.

xiii. Identify and resolve requests rejected by the medical plan, including access to a comparable drug regimen; refer to the pharmacist in case of possible pharmaceutical alternatives.

xiv. Monitor assistance balances for each enrolled patient to ensure funds are available until the completion of therapy; e.g., economic aids.

xv. Communicate and coordinate the obtaining of copay/deductible for the medication.

xvi. Coordinate the delivery of medications directly with the patient or their authorized representative, medical office, and/or infusion center. Coordination includes ensuring the place, day, and time of delivery.

xvii. Identify and follow up on refill dates to ensure patients receive their medication on the appropriate dates in compliance with the treatment plan.

xviii. Other tasks: perform or assist with any operations as necessary to maintain workflow and meet schedules and quality requirements; participate in meetings and workgroups prepared by management or coworkers. Stay informed of new developments, requirements, and policies.

xix. Escalate any extraordinary situations to the supervisor or manager, availability for weekly meetings.

Minimum requirements:

• Associate degree as a Pharmacy Technician is required
• Valid Pharmacy Technician license is required
• Minimum 1 year of customer service experience with knowledge of pharmacy benefit access processes (preferably)