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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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 market team would like to hire temporary pharmacy coordinators to assist in closing quality care gaps related to pharmacy. These positions will be member focused and will be primarily used to coordinate between members, providers, and pharmacies in order to increase medication adherence.
They will be on the phone with members and pharmacies to coordinate these medication fills. This position would need to be able to manipulate and excel sheet to identify members they need to call and track their progress.
Currently the pharmacy team does not have staff to do this, so this is filling a current gap.
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 pharmacy coordinator will review their call list for the day and call members based on priority of medications adherence. They will discuss medication adherence with the members they are able to contact and encourage them to fill their medications.
Each call will need to be tracked on their spreadsheet along with the outcome of the call. They will need to notate if they were able to reach the member and also document success of phone call.
We will be tracking number of calls and number of subsequent medication fills
This role currently does not exist in the market
Candidate Requirements
Education/Certification
Required: High School Diploma
Preferred:
Licensure
Required: Pharmacy Technician
Preferred:
Years of experience required: 2+
Disqualifiers: n/a
Additional qualities to look for: Want to make sure they are comfortable speaking to members and pharmacies about medications
- Top 3 must-have hard skills stack-ranked by importance
1
Communication Skills
2
Medication knowledge
3
Experience in pharmacy
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:
Phone- manager will provide her phone number ad candidate will call her at the scheduled time
Required Testing or Assessment (by Vendor):
Next Steps
- Do you have any upcoming PTO?
No
- Colleagues to cc/delegate
