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Providence Health & Services Senior Pharmacy Technician Managed Care in Washington

Description:

Providence St. Joseph Health is calling a Senior Pharmacy Technician Managed Care to our location in Beaverton, OR. This position will be remote for the remainder of 2021 and may pivot to a hybrid model in 2022 working a combination of in office and remote. We are seeking candidates that are available in commute distance to the office in Beaverton, OR.

This position is responsible for completion and performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of the Quality Medical Management Division. Position includes integrating technical pharmacy aspects with that of Medical Review, Formulary Development & Submissions, Case Management, Mental Health/Chemical Dependency, and Quality Management. Technician responsibilities include communicating directly with Providence Health Plan (PHP) Customer Service and PHP Members, PHP Network Pharmacies, and regulatory entities at the federal and state level. The position also communicates directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives.

The Senior Pharmacy Technician is highly skilled, strong attention to detail, and consistently demonstrates expertise in multiple pharmacy systems and functional work areas within the division, able to shift support to various programs or services to efficiently and effectively support members, other caregivers, and pharmacy division priorities. Looks for opportunities to improve automation as well as quality and efficiency of work, in ultimate support of our members and fellow caregivers. Consistently looked to for guidance an

In this position you will:

• Coordinates and processes independently pharmacy prior authorizations taking into consideration pharmacy benefits, medication utilization policies, documented technician approval criteria, information submitted by prescriber, and age-related presentation of member requesting.

• Maintains pharmacy benefit member eligibility review process and database. Oversees point-of-service claims transactions processed on a daily basis through Argus Health System. Refers unusual occurrences to Argus Analyst/Coordinator.

• Takes, triages and documents incoming calls and requests, identifies and obtains resource for those requiring immediate attention, handles those appropriate through established protocols utilizing appropriate level of assessment and judgment. Routes work to other resources as deemed appropriate. Monitors, retrieves, and prioritizes incoming work as required.

• Performs intake and system data entry of information such as authorization and referral requests, patient information, discharge information, medication therapy management information, drug utilization management information. Uses sound judgment in identifying the need for clinical review or pharmacist/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures. Maintains the accuracy and integrity of the database.

• Determines and assigns appropriate and correct coding such as length of service, level of care, diagnosis and procedure, and system identifiers. Identifies medical cases for review by using ICD-9 and CPT-4 coding systems.

• Provides technical assistance and coding support to Clinical Reviewers by using PAS, ICD and CPT coding systems to ensure accurate diagnosis and procedure codes.

• Initiates information system search for needed documentation and information for cases and their review. Assists in the development and maintenance of loss reports.

• Notifies physicians and other prescribers of prior authorization and specific medication utilization issues, including communication of clinical status and documentation of such notification.

• Acts as department liaison and resource to members, Health Plan providers, and Health Plan departments to problem solve or address inquiries regarding work, workflow, processes, information system issues and relationships.

• Communicates with members, patients, network pharmacies and providers to obtain information, signatures and appropriate sign off in order to facilitate workflows. Develops written communications to prescribers and network pharmacies as directed.

• Audits processed pharmacy claims, system call documentation, and written correspondence for quality ensuring information is correct, complete, and clear.

• Communicates and serves as a resource to Customer Service, marketing staff, provider relations staff, pharmacies, physicians and others. Develops written communications such as frequently asked questions as needed.

• Trains and assists provider and office staff, members and payors, operations department and other Health Plan employees in UQM/RX processes and system usage as applicable. Serves as knowledge holder on pharmacy matters within the health plan and serves as a consultant as needed and within scope of position.

• Continuously monitors security and safety of medical records and medical information to protect confidentiality. Purges medical and other records as required according to established protocols.

• Reports statistical information on work unit activity. Collects and analyzes data and develops reports to indicate quality and effectiveness of work. Recommends and initiates change to ensure continuous quality improvement in work processes.

• Researches pended claims and authorizations or incomplete medical records and provides resolution or recommendations for solution.

• Identifies, notifies, documents and distributes information related pharmacy department work, and patient follow-ups, alerting the appropriate people as necessary.

• Authorizes payment of pharmacy claims and DMR's (direct member reimbursements) according to established departmental policies.

• Collects, organizes, reviews and verifies records submitted by prescribers and network pharmacies knowing that records are subject to both federal and state review and/or audit.

• Maintains sound working knowledge of all relevant policies and procedures. Develops written procedures for workflow processes.

• Supports formulary management program through maintaining processes for ongoing and compliant formulary filing and publishing

• Supports pharmacy policy development, automation and implementation via pharmacy systems.

• Supports continuous process and quality improvement; helps to solve complex problems and development of innovative solutions, and serves as a mentor or functional lead to help implement changes and serve as mentor among pharmacy technician peers.

• Digests new regulatory information and able to adapt and support impact to daily work.

• Skilled in pharmacy network administration and ongoing maintenance

Qualifications:

Required qualifications this position include:

Education:

License/Certification:

• National Certification as Pharmacy Technician within one year of employment.

• Licensure in Oregon as a Pharmacy Technician upon hire.

Experience:

5 years Experience as a pharmacy technician in a managed care or pharmacy benefit management environment

Demonstrated work history of exceeding service standards, adaptability to working in various pharmacy work units, and key contributor to supporting major projects and/or implementations

KNOWLEDGE, SKILLS and ABILITIES

Demonstrated problem solving skills

Demonstrated written communication skills

Strong verbal communication and listening skills

Promotes information sharing

Excellent collaboration and team building skills

Ability to build strong customer relationships

Ability to simultaneously handle multiple priorities

Assumes personal responsibility for actions

Demonstrates excellent judgment and decision making skills

Excellent organizational skills

Highly thorough and dependable

Maintains composure under pressure

Performs work independently with minimal supervision

Possesses a high degree of initiative

Seeks to acquire knowledge in area of specialty

Proactively approaches responsibilities

Demonstrates a high commitment to quality

Preferred qualifications for this position include:

Education:

Bachelor's Degree

License/Certification:

• National Certification as Pharmacy Technician within one year of employment.

• Licensure in Oregon as a Pharmacy Technician upon hire.

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work

environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team

member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our

patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees

create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor,

introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and

updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their

concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision

is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our

award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the

Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of

Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our

many options in Oregon.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Pharmacy Technician

Location: Oregon-Beaverton

Other Location(s): Washington, Oregon

Req ID: 323523

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