Pharmacy Technician Specialist - Care Management

Suffolk, MA

Point32Health

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POSTED ON: 06/03/2023

Suffolk, MA

Pharmacy Technician Specialist - Care Management

Under the direction of the Clinical Pharmacist, Care Management, the Pharmacy Technician is responsible for supporting Care Management teams in all aspects of day- to -day functions. Additional responsibilities include responding to inquiries and appropriate follow up; supporting the team with projects, gathering data and information to report on member issues.

Key Responsibilities/Duties – what you will be doing

Serve as a resource to care management teams for drug inquiries pertaining to formulary, tier, prior authorization, cost share.

Educate members about federal, state and other programs/resources that assist with out-of-pocket medication costs, including assist with accessing eligible- programs/resources

Assist members under care management with medication copay assistance programs and adherence solutions

Assist members with barriers in obtaining medications at pharmacy point of sale

Perform in person member face-to-face visits as needed to provide medication education and/or resolve drug related problems

Work cross-functionally with pharmacy departments to resolve assigned member related problems

Schedule patient appointments for medication review consultations and other quality initiatives

Communicate and obtain pertinent information for consultation from members, physician offices and case managers

Document notes in the appropriate tracking system

Provide support to clinical pharmacist by outreaching members as part of quality initiatives and other project as needed

Maintain and modify databases to track drug related problem interventions made in the department

Creates, maintains and updates documents and grids that support the work of the Care Management quality initiatives

Provide a variety of administrative functions to support care management programs

Serve as a resource to others within the department

Participate in meetings as necessary

Qualifications – what you need to perform the job

EDUCATION:

(Minimum education & certifications required)Certified Pharmacy Technician (CPh

T) required

Associate’s degree in Healthcare, Nursing, Pharmacy or a related area or equivalent experience required

Bachelor’s degree in health care or related field preferred

EXPERIENCE:

(Years of experience)Minimum of 3-4 years of experience in health care or health insurance industry preferred. Experience in retail and hospital pharmacy or managed care pharmacy industry required. Experience working with Medicare Parts B and D and Medicaid Plans preferred.

Must be able to work well independently and be self-directed.

Proficient in MS Office-Excel, Word, , and Power

Point required. Microsoft Access preferred.

Software/Database experience-THP systems such as Med

HOK, Rx

Claims, CCMS,CAS, Trizetto and Medical Claims systems Reflections (SYSA, Diamond, Redbrick, Forest & Trees and Cognos) or other database/software experience is preferred

SKILL REQUIREMENTS:

(Include interpersonal skills)Excellent analytical skills necessary to interpret member level data and reports and to prepare summary documents for distribution and presentation to both internal and external stakeholders. Must have excellent oral and written communication skills, including preparation of presentation-ready materials.

Proven time management and organizational skills. Ability to manage multiple tasks, workflows, responsibilities and maintain accuracy in all elements of the position.

Work effectively as an integral member of the Pharmacy Care Management Teams.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:

(include special requirements, e.g., lifting, travel to member homes, overtime)Fast paced office environment handling multiple demands. Must be able to exercise appropriate judgment as necessary. Open cubicle work setting with a personal computer.

CONFIDENTIAL DATA:

All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary.

These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.

THIS DESCRIPTION IS NOT INTENDED TO BE A COMPLETE STATEMENT OF JOB CONTENT; RATHER IT ACTS AS A GUIDE TO THE ESSENTIAL FUNCTIONS PERFORMED. MANAGEMENT RETAINS THE DISCRETION TO ADD TO OR CHANGE THE DUTIES OF THE POSITION AT ANY TIME.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts.

Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Talent

Boost is now Ignyte AI.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law

Req ID:

R6633

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