Allied / Tech - Pharmacy Tech

Allied / Tech - Pharmacy Tech

This position is responsible for performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of Healthcare Experience & Operations Division. Position includes integration of technical pharmacy aspects with that of medical review, case management, mental health/chemical dependency, and quality management. Technician responsibilities include communicating directly with Providence Health Plan (PHP) Customer Service and PHP Members, PHP Network Pharmacies, and regulatory entities at the federal and state level. The position also communicates directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding claims, medication management programs, and initiatives.

Duties:

• Excellent member care to find solutions and ease members way during first contact communications.
• Maintaining excellent customer service to our external partners such as pharmacy network, prescriber, and caregivers to maintain strong relationships throughout all interactions.
• Functioning as a liaison and problem solver with multiple providers (physicians, pharmacists, office staff, hospital staff, member, and payor), or Plan departments.
• Identification and response to requests for medical preauthorization which require immediate determination by a Clinical Reviewer or Clinical Pharmacist.
• Management of multiple priorities and time deadlines efficiently and effectively through ability to work independently while cognizant of team environment and areas that require collaboration.
• Administration of pharmacy benefits, pharmacy network contracts, and employer group contracts in a manner that achieves PHP's mission, vision, values, and regulatory obligations while meeting the needs of the individual.
• Understanding of medical drug benefits and channel management (contracted network and policies).

Education: Bachelors Degree or at least 2 years of Experience as a pharmacy technician in a managed care environment. (handling prior authorization review and mandatory audits across all lines of business -Medicare, Medicaid, Commercial Fully Insured, Individual, ASO).