Pharmacy Technician

Essential Job Functions

• Assists in managing Health Plan and various affiliated Health Plan specific reports that impact medication adherence, medication reconciliation, and other STARs and HEDIS measures.
• Oversees and manages the pharmacy concierge team (outreach team).
• Incorporates new strategies to improve member outreach affecting STARs related medication adherence measures.
• Supports Pharmacy Benefit Manager (PBM) operations, including monitoring claims processing, assisting with prior authorization coordination, reviewing pharmacy reports, and collaborating with PBM partners to ensure compliance with contractual, operational, and regulatory requirements.
• Responsible for managing member, provider, and vendor outreach that impact Part D quality initiatives using data entry to track outcomes of all communications and outreach.
• Collaborates with healthcare professionals of all levels involving patient medications.
• Phone and fax for Provider office outreach to obtain confirmation of prescription and other required data.
• Provides education for the PCP offices and staff for the Part D STAR and HEDIS measures.
• Confirms eligibility and benefits, while providing support for services based on member guidelines.
• Provides support to the clinical pharmacists that are performing Medication Therapy Management for Health Plan members.
• Attends daily multidisciplinary health care team meetings and works with the pharmacist to provide recommendations as needed involving patient drug therapies.

Marginal Job Functions

• Takes on special projects as needed.

Behavioral Expectations

• Continuous Learning: Attends staff meetings as required. Attends appropriate training, seminars and workshops as required.
• Customer Focus: Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct. Fosters appropriate communication and relations with Supervisor, co-workers, and other staff.
• Quality/Process Improvement/Safety: Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable. Supports and demonstrates safety throughout all duties performed. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities.

Position Requirements

• Educational/Experience: High school diploma or equivalent required. Spanish speaking preferred but not required. 1+ years of experience in the healthcare industry preferred. Medicare Part D experience preferred. Retail pharmacy experience is an advantage. Experience supporting PBM monitoring, reporting, or oversight activities is highly preferred.
• Skills/Knowledge/Ability: Proficiency with Microsoft Office Suite: Word, Excel, Outlook, and Power Point. Solid ability to prioritize tasks and manage multiple tasks simultaneously. Ability to read, write, speak, and understand English proficiently. Exercises excellent written, verbal, listening and interpersonal communication skills necessary to effectively interact with all levels of internal and external parties, to convey information correctly, and manage challenging situations. Strong attention to quality and detail. Excellent communication skills necessary to provide accurate information to members and collaborating staff. Ability to analyze information provided. Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team. Adheres to maintaining high level of confidentiality and privacy. Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand. Willingness and ability to take initiative and be a self-starter. Willingness and ability to understand and comply with Federal, State, and local regulations.
• Licensure/Certificate/Training: Current and clear PTCB certification through the designated PTCB training program and/or state required certification/registration.