Pharmacy Technician

Reference Number: GimJI2
Location: Florham Park, New Jersey, US;Philadelphia

Pharmacy Specialist

They are accountable for supporting and assisting in the coordination of Pharmacy Services benefits, including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects. This position must ensure performance is in compliance with organizational or departmental goals and in compliance with regulatory agencies. They must process prior authorization requests received via fax or prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on clinical criteria.

    • Responsible for all telephonic interaction with members, physician office staff, pharmacies and internal stakeholders for Pharmacy eligibility, coverage determination, and/or claim issues.
    • Engagement with physicians & pharmacists to conduct effective interventions through clinical therapeutic interchange to facilitate formulary compliance, optimize generic dispensing, and consistency with the current plan design.
    • Capture accurate and comprehensive clinical information for Prior Authorization requests from physicians and/or medical office staff to allow for clinical review and medical necessity determination.
    • Responsible for satisfying all departmental customer service quality metrics while ensuring that all DMAHS and DOBI required regulatory turnaround times are consistently satisfied.
    • Process complaints, appeals, grievances, executive inquiries and compliance related issues.
    • Responsible for identifying via interactions with members and providers, instances of potential fraud, waste, and abuse and resulting internal referrals that are necessary.
    • Provide recommendations to increase efficiency, accuracy and productivity in the department.
    • Process ad hoc request for information or reports from stakeholders.
    • Accountable for independent and group learnings to ensure understanding of pharmacy services procedures and workflows.
    • Assist in the day-to-day business functions of the pharmacy department as well as the Medication Therapy Management program.
    • Provide support to various clinical programs within the pharmacy department.

Education/Experience:

    • Requires a High School diploma or GED
    • Requires National Pharmacy Technician Certification (PTCB or ExCPT)

Requires prior customer service/service quality initiative experience.

Admin/Clerical Staff
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