JOB DESCRIPTION
JOB TITLE: Pharmacy Technician FLSA STATUS: Non-Exempt
DEPARTMENT: Pharmacy Department
REPORTS TO: Pharmacy Supervisor
JOB SUMMARY: Assists the pharmacist in managing reports and programs that impact medication adherence, medication reconciliation, and other Medicare Part D STAR and HEDIS measures. Supports member and provider outreach initiatives to improve quality outcomes and member satisfaction. This role also assists with monitoring and oversight of Pharmacy Benefit Manager (PBM) operations, including reviewing pharmacy reports, supporting claims monitoring activities, and collaborating with PBM partners to ensure compliance with operational, contractual, and regulatory requirements.
ESSENTIAL JOB FUNCTIONS:
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Assists in managing Health Plan and various affiliated Health Plan specific reports that impact medication adherence, medication reconciliation, and other STARs and HEDIS measures.
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STARs and HEDIS measures include but not limited to Adherence to Diabetes, Hypertensive (RAS Antagonists) and statin medications; Statin Use in Persons with Diabetes (SUPD); Comprehensive Medication Review (CMR); Statin Therapy in Patients with Cardiovascular Disease (SPC).
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Oversees and manages the pharmacy concierge team (outreach team). Incorporates new strategies to improve member outreach affecting STARs related medication adherence measures.
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Supporting Pharmacy Benefit Manager (PBM) operations, including monitoring claims processing, assisting with prior authorization coordination, reviewing pharmacy reports, and collaborating with PBM partners to ensure compliance with contractual, operational, and regulatory requirements.
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Responsible for managing member, provider, and vendor outreach that impact Part D quality initiatives using data entry to track outcomes of all communications and outreach. Collaborates with healthcare professionals of all levels involving patient medications.
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Direct member outreach to address adherence gaps by identifying/addressing barriers.
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Phone and faxing for Provider office outreach to obtain confirmation of prescription and other required data.
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Provides education for the PCP offices and staff for the Part D STAR and HEDIS measures.
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This position will confirm eligibility and benefits, while providing support for services based on member guidelines. Plays a key role in maintaining an elevated level of patient satisfaction by providing patients with exceptional customer service and serving as the liaison between patients, physicians, and pharmacies
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Contacts patients to initiate or provide reminder for follow-up office visits and managing turn-around times for call-backs.
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Providing support to the clinical pharmacists that are performing Medication Therapy Management for Health Plan members.
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Attends daily multidisciplinary heath care team meetings and works with the pharmacist to provide recommendations as needed involving patient drug therapies.
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Practices discretion and care on a regular basis when working with sensitive/confidential data pertaining to the patient, department, or company.
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Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
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Maintains regular and consistent attendance.
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Adheres to Compliance Plan and HIPAA regulations.
MARGINAL JOB FUNCTIONS:
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Takes on special projects as needed.
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Performs other duties as assigned.
BEHAVIORAL EXPECTATIONS:
1. Continuous Learning:
a. Attends staff meetings as required.
b. Attends appropriate training, seminars and workshops as required.
2. Customer Focus:
a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations
and IMAS’s Standards of Conduct.
b. Fosters appropriate communication and relations with Supervisor, co-workers, and other staff.
3. Quality/Process Improvement/Safety
a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.
b. Supports and demonstrates safety throughout all duties performed.
c. Follows established policies and procedures and understands and complies with all regulators
standards set forth by governing entities.
POSITION REQUIREMENTS:
EDUCATION/EXPERIENCE:
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High school diploma or equivalent required.
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Spanish speaking preferred but not required.
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1+ years of experience in the healthcare industry preferred.
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Medicare Part D experience preferred.
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Retail pharmacy experience is an advantage.
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Experience supporting PBM monitoring, reporting, or oversight activities is highly preferred.
SKILLS/KNOWLEDGE/ABILITY:
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Proficiency with Microsoft Office Suite: Word, Excel, Outlook, and Power Point.
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Solid ability to prioritize tasks and manage multiple tasks simultaneously.
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Ability to read, write, speak, and understand English proficiently.
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Exercises excellent written, verbal, listening and interpersonal communication skills necessary to effectively interact with all levels of internal and external parties, to convey information correctly, and manage challenging situations.
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Strong attention to quality and detail.
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Excellent communication skills necessary to provide accurate information to members and collaborating staff.
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Ability to analyze information provided.
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Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
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Adheres to maintaining high level of confidentiality and privacy.
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Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
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Willingness and ability to take initiative and be a self-starter.
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Willingness and ability to understand and comply with Federal, State, and local regulations.
LICENSURE/CERTIFICATE/TRAINING:
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Current and clear PTCB certification through the designated PTCB training program and/or state required certification/registration.
