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Mason

    Pharmacy Technician III - Mason, United States - Elevance Health

    Elevance Health
    Elevance Health Mason, United States

    3 weeks ago

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    Description
    Pharmacy Technician III - Resolutions

    This position will work a hybrid model (remote and office), 1-2 times per week in office. The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

    CarelonRx Pharmacy is now part of CarelonRx (formerly IngenioRx), a proud member of the Elevance Health family of companies.

    The CarelonRx Home Delivery Pharmacy will deliver a digital first pharmacy experience that is convenient, simpler to use, and more affordable for our patients and payors.

    Our Pharmacy model focuses on whole person care, providing the best member experience to drive adherence, affordability, and improved overall health outcomes by putting the patient first.


    This role will perform all pharmacy technician duties under the regulatory authority of the state they are practicing in and aid in the dispensing of prescriptions to patients by the CarelonRx Pharmacist.

    Responsible for complex pharmacy, patient, and prescriber encounters, including, but not limited to prescription claim adjudication exceptions, returns, reships, drug recalls, and patient and prescriber escalations

    How you will make an impact:
    Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs.


    Serves as the subject matter expert, proactively manages service failures and workflow in our contact center tool and our prescription processing system.


    Partner and support pharmacists in the performance of their duties, including outreach to patients and prescribers for resolution on open issues.


    Processes prior authorization requests from physicians and ensures compliance with all regulatory requirements; informs relevant parties of all prior authorization determinations.

    Provides resolution to grievances and appeals issues.


    Managing inbound and outbound communications, triaging and problem-solving pharmacy inquiries, ensuring any related patient and prescriber communication is completed and resolving all related open cases across patient services tool and pharmacy processing system, and managing prescription queue workflow.

    Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports.


    Mentor and train lower-level pharmacy technicians as needed; as well as lead pharmacy technicians working prescription queue-based assignments to ensure quality, meeting turnaround times, and delivering on patient, prescriber, and client experience and expectations.


    Minimum Requirements:
    Requires H.S. diploma or equivalent and minimum of 5 years of pharmacy experience.

    Requires an active, professional license, if required by state law(s), State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.

    Experience with PBM/Plan insurance setup and processing and claims adjudication and resolution of reject messaging required.


    Preferred Capabilities, Skills, and Experiences:
    Experience in high volume mail order or specialty pharmacy preferred.


    Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

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