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.ResponsibilitiesReceive and respond to provider and pharmacy calls regarding the prior authorization and formulary processPerform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelinesTrack and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patternsResolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy teamAssist Provider Relations and various departments with educating providers on the health plan’s pharmacy processAssist with the pharmacy utilization review and reporting processCollaborate with Quality Improvement department with various meeting preparation and transcription of minutesAssist with members’ inquiries related to the formulary processPerforms other duties as assignedComplies with all policies and standards
PDP membership expected to be 11.4M or greaterrefresher of req 185251-1
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's pay range is $7.25/hr - $80.00/hr.
