*Candidate can be remote in the state of Oregon OR SW Washington**
This position is responsible for coordination and performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of the Quality Medical Management Division. Position includes integrating technical pharmacy aspects with that of Medical Review, Case Management, Mental Health/Chemical Dependency, and Quality Management. Technician responsibilities include communicating directly with Customer Service and Members, Network Pharmacies, and regulatory entities at the federal and state level. The position also communicates directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives.
- Coordinates and processes independently pharmacy prior authorizations taking into consideration pharmacy benefits, medication utilization policies, documented technician approval criteria, information submitted by prescriber, and age-related presentation of member requesting.
- Maintains pharmacy benefit member eligibility review process and database. Oversees point-of-service claims transactions processed on a daily basis through Argus Health System. Refers unusual occurrences to Argus Analyst/Coordinator.
- Takes, triages and documents incoming calls and requests, identifies and obtains resource for those requiring immediate attention, handles those appropriate through established protocols utilizing appropriate level of assessment and judgment. Routes work to other resources as deemed appropriate. Monitors, retrieves, and prioritizes incoming work as required.
- Performs intake and system data entry of information such as authorization and referral requests, patient information, discharge information, medication therapy management information, drug utilization management information. Uses sound judgment in identifying ! the ne! ed for clinical review or pharmacist/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures. Maintains the accuracy and integrity of the database.
Required Skills & Experience
- 2+ years of experience as a pharmacy technician in a managed care environment, OR 3 years pharmacy technician experience in an outpatient pharmacy
- Great customer service
- Quick thinking
- Inpatient experience preferred
- Oregon Pharmacy Technician License
Nice to Have Skills & Experience
- Inpatient experience
- Call center experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.