Under the direction of the Care Management Pharmacist(s), performs a variety of pharmacy-related duties supporting the initiatives of WellSpan Population Health Services (WPHS) and WellSpan Provider Network in the provision of value-based pharmaceutical care.
Duties and Responsibilities:
1 Assists pharmacists as directed including impromptu tasks or requests.
2 Provides exceptional customer service with inbound/outbound calls and pharmacy inquiries that require elevation from other departments.
3 Enters and/or retrieves data established from computer files using knowledge of various computer software applications and Epic.
4 Trains other employees in department compliance and procedures.
5 Reviews physician inquiries for pre-certification and medical necessity requests based on established internal guidelines and contract criteria.
6 Verifies member coverage for pharmacy/medical eligibility including monitoring Coordination of Benefits in the TPA business.
7 Facilitates and completes the prior authorization process.
8 Manages communications to physician offices/pharmacies/members to obtain additional information and to keep physicians/pharmacies/members aware of current order status.
9 Communicates any suspected offenses against company policies.
10 Keep abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge into job duties.
11 Identifies and becomes the owner of problems and OFIs in pharmacy related processes/procedures or services as an active participant in the LDMS process.
12 Maintains a balance of productivity, quality and timeliness of job accountabilities. Participates in department self-audit procedures for ongoing evaluation of service.
13 Enters application information, prior authorizations and other relevant data. Generates reports and other information requested on a scheduled/as needed basis.
Care Management Pharmacy Technician (Population Health)
14 Ability to receive complaints/issues and troubleshoot for a temporary and/or long-term solution.
High School or G.E.D.
National Pharmacy Technician Certification (PTCB or NCCT)
3 years experience in the pharmacy field required
Knowledge of third party administration pharmacy management workflows, health plan benefits, and the role of a Pharmacy Benefit Manager preferred
Wellspan Health System