Job Details

Job Full Description

Remote Licensed Pharmacy Technician

Temporary with the possibility of long term

$40k-$50k

Accountable for supporting medical management functions (utilization management, pharmacy management, and care coordination) with expertise in appropriate areas. Follow company's policies and procedures, practice guidelines, state and federal guidelines and regulations, and other medical management resources. Serve as liaison to Oregon Health Plan members, providers, pharmacies, and community healthcare personnel. Works under greater supervision with guidance from more experienced staff and focuses on performing standard medical management clinical review tasks.

Regulatory Compliance:

• Maintain updated knowledge of the Oregon Administrative Rules (Medicaid) governing coverage determinations.
• Comply with organization's internal policies and procedures, code of conduct, compliance plan, along with applicable Federal, State, and local regulations

Utilization Review:

• Perform initial review of requests for coverage of pharmacy and medical services. Make decisions in a logical, consistent manner. Provide clear and accurate documentation of the reasoning process for decisions within allotted timeframes
• Effectively navigate and apply the Health Evidence Review Commission Prioritized list of Health Services
• Follow utilization management guidelines with few errors and consistently score 80% or above on inter-rater reliability testing.
• Evaluate the cost of effectiveness of proposed/delivered services before, during, and after claims data with consideration to medical necessity, the quality of care, and the appropriateness of the delivery of care, and covered benefits
• Utilize applicable resources and systems to prepare materials for pharmacist review, including documentation of key findings, benefit determination, verification of codes and pricing, supporting standard citations, care plans, risk appraisals, and alternative treatment options
• Communicates with providers on formulary or lower cost alternatives, prior authorizations, and step therapy guidelines as well as state and federal criteria for services and supplies
• Perform data entry into claims adjudication system with a high level of accuracy

Care Coordination:

• Assist with Medication Management program daily responsibilities including contacting members, pharmacies, and providers as needed to complete MedSynch and assist pharmacist with MM schedule
• Assist other departments in coordinating medication services for members by answering questions and resolving identified barriers
• Educate members and practitioners about health plan benefits structure and relevant rights and responsibilities
• As needed, work the company's grievance and appeals coordinator with they receive calls from a member or the member's representative regarding concerns about the care being provided
• Assisting pharmacies as needed to ensure timely dispensing of medications

Challenges:

• Working with a variety of personalities, maintaining a consistent and fair communication style
• Satisfying the needs of a fast paced and challenging company

Qualifications:

• Current National and Oregon Certified Pharmacy Technician (CPhT) licensure.
• 1+ years' experience as a pharmacy technician.
• Fluent in pharmaceutical and medical terminology.
• Proficient PC navigational, MS Office (Word, Excel, Outlook), data entry, and internet research skills.
• No suspension/exclusion/debarment from participation in federal health care programs (e.g. Medicare/Medicaid)
• Managed care experience.
• Ability to provide excellent customer service to internal and external customers.
• Effective written, verbal, and interpersonal communication skills.
• Ability to effectively collaborate with others and function as a part of a highly functioning team.
• Excellent self-discipline to meet deadlines and follow policies, procedures, and workflows in a remote environment.
• Excellent critical thinking and time management skills required to organize and prioritize workload according to goals and specified turnaround times.
• Demonstrated transferable knowledge, skills, and ability to complete job duties independently and proficiently.
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Proficient computer skills, including MS Office suite
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Experience working on a diverse team with different communication styles.
• Bi-lingual translation or translation capabilities a plus

Roseburg, OR
2106
741 Northeast Garden Valley Boulevard
Roseburg, OR 97470