Match score not available

Pharmacist Navigator- Managed Care/PBM

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Doctor of Pharmacy from accredited school, Current unrestricted pharmacy practice license, Three years experience as pharmacist in managed care.

Key responsabilities:

Handle pharmacy coverage and benefits inquiries
Educate patients on medications and coverage
Consult and align priorities with commercial operations
Collaborate on program improvements and cost-saving strategies
Provide support for clinical program outcomes and reports

WVU Medicine XLarge https://www.wvumedicine.org/

10001 Employees

See more WVU Medicine offers

Job description

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.

The Pharmacist Navigator is primarily responsible for Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution. This position is responsible for outbound phone calls to members, prescribers, and/or pharmacies to ensure member satisfaction, demonstrate compassion and care, optimize the customer experience, and provide professional member support and service. The Pharmacist Navigator will need to effectively ask probing questions to identify and resolve multiple issues and address concerns, effectively, efficiently, and in a timely manner. The primary duty of this position is to educate patients about their medications, conditions, and pharmacy benefits to achieve optimal participant care outcomes.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Doctor of Pharmacy from an accredited school of pharmacy.

2. Must possess current and unrestricted license to practice pharmacy. Licensure must be completed within 90 days of hire. If licensure is not obtained within 90 days of start date, associate will be notified that they will be released from their employment.

EXPERIENCE:

1. Three (3) years of experience as a pharmacist in a managed care setting

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Board certification and/or managed care program certificate in applicable clinical field

EXPERIENCE

1. Experience in communication of member issue resolution

2. Specific knowledge of CMS regulations, HIPAA and regulatory environment preferred

3. Experience in pharmacy formulary strategy and/or pharmacy benefits design preferred

4. Experience with population health initiatives, care management programs, and navigation of patient assistance programs (PAP) preferred

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Serves as a consultant to Peak Commercial and Medicare pharmacy operations team to align priorities and execute on initiatives

2. Serves as a liaison between internal departments (such as care management, member services) and PBM Client Account Executives to provide best-in-class care to enrollees and aid in issue resolution

3. Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities, and by contributing on-going consultation and collaboration with product leaders

4. Development and execution of ‘white-glove’ processes to ease member transitions from formulary disruptions, pharmacy network changes, etc.

5. Identifies innovative strategies to impact Plan’s quality and clinical goals and outcomes

6. Collaborates with key internal stakeholders, external clients, and Plan’s pharmacy benefit manager to identify areas of potential cost-saving and quality improvement initiatives based on identification of trends and customer service escalations

7. Assesses PBM clinical program outcomes using data-driven analyses and determines opportunities for improvement

8. Work with clinical, quality, and data analytics teams and others as needed, to ensure that data needs are identified and incorporated into the process including performing data analysis as needed

9. Provide in-service education and training on pharmacy-related topics

10. Assist in creation and delivery of presentation and communications for various internal and external projects and meetings

11. Participates in meetings with clients and external partners to ensure optimal pharmacy benefit delivery and optimization of client member experience

12. Develop new clinical strategies to improve the health of our members by analyzing and interpreting trends from discussions with members, providers, and/or pharmacies

13. Assists in development of cost-saving strategies while optimizing clinical outcomes

14. Translate and decipher how current pharmacy/healthcare trends will affect our clinical strategies

15. Ensures compliance with all regulatory guidelines, including but not limited to ERISA and CMS

16. Monitors issues to find opportunities for processing improvement or education

17. Provide drug information and act as the clinical consultant/expert on the pharmacy services team

18. Provide support and consultation for key documents such as pharmacy directory and formulary directories, client-facing policies, and website content, and referencing CMS guidance (or other applicable guidance) when applicable to creation of those documents

19. Special projects as assigned

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Some travel may be required to offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work independently or cooperatively as a team member.

4. Experience with regulatory and accreditation standards.

5. Ability to work in a fast-paced and rapidly changing environment.

6. Extensive working knowledge of Microsoft Office applications (Excel and Access).

7. Strong interpersonal and team skills with ability to work and interact externally and internally.

8. Knowledge of PBM Industry/Managed Care industry.

9. Strong focus on customer service, quality, and accuracy.