Job Profile Summary
Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state’s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.
For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.
For Centene Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.
Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
Assist with the pharmacy utilization review and reporting process
Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
Assist with members’ inquiries related to the formulary process
Performs other duties as assigned
Complies with all policies and standards
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Job Profile Summary
Position Purpose:
Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
Education/Experience:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
For Superior Health Plan:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
License/Certificate: Current state’s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.
For Arizona Complete Health:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
License/Certificate: Current Arizona Pharmacy Technician license.
For Centene Pharmacy Services:
High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
License/Certificate: Current state's Pharmacy Technician license preferred.
Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
Assist with the pharmacy utilization review and reporting process
Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
Assist with members’ inquiries related to the formulary process
Performs other duties as assigned
Complies with all policies and standards
Story Behind the Need
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
The team’s purpose is responsible for building and maintaining decision tools, also known as questionnaires. These tools support pharmacy operations, specifically around prior authorization processes. We develop and manage configurable questionnaires that align with health plan and drug policies which help the prior authorization reviewers make their determination.
We are a collaborative and supportive team that values clear communication, accountability, and continuous improvement. This team works cross-functionally with other pharmacy operational teams. We’re part of a large pharmacy department that is focused on optimizing workflows and improving patient outcomes through smarter, more efficient tools.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
The team’s purpose is responsible for building and maintaining decision tools, also known as questionnaires. These tools support pharmacy operations, specifically around prior authorization processes. We develop and manage configurable questionnaires that align with health plan and drug policies which help the prior authorization reviewers make their determination.
We are a collaborative and supportive team that values clear communication, accountability, and continuous improvement. This team works cross-functionally with other pharmacy operational teams. We’re part of a large pharmacy department that is focused on optimizing workflows and improving patient outcomes through smarter, more efficient tools.
Candidate Requirements
Education/Certification
Required: high school diploma
Preferred:
Licensure
Required:
Preferred: prefer a Pharmacy Technician License but not required.
Years of experience required: 3+ years of Pharmacy Technician experience (open to PBM, retail, or other various experience)
Disqualifiers:
Additional qualities to look for: Ability to multitask or properly prioritize work, Experience with projects or assignments that require attention to details.
- Top 3 must-have hard skills stack-ranked by importance
1
Pharmacy Technician experience (open to PBM, retail, or other various experience)
2
Microsoft Office Experience – Excel, Word, Outlook, Visio
3
Ability to work independent and keep good communication with about their project/assignment updates.
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams-camera on
Required Testing or Assessment (by Vendor):
