- Serve as an initial point of contact and facilitate timely and accurate preparation of referrals for pharmacists by independently obtaining medication history (i.e., drug, dose, route, frequency, indications), verification of eligibility, formulary and benefit information, and verification of allergies. Ensure all elements are appropriately captured and documented for review.
- Perform telephonic and written outreach to members and providers/pharmacies to address medication non-adherence, prevention of avoidable hospital admissions or readmission, medication reconciliations, or other drug utilization activities to improve member and quality outcomes.
- Coordinate prior authorization needs with the PBM and/or the Pharmacy Services team to improve gaps in medication management as needed.
- Work collaboratively with internal teams including the clinical pharmacy -, case management -, and other quality or clinical teams on projects and ensure seamless communications occur both internally and externally as needed.
- Provide support to clinical pharmacy team related to the administration of medication management programs (MTMP) including coordinating meetings with internal and external audiences, completing necessary intervention forms and documentations in all appropriate database(s). All appropriate documentation should be accurate and timely, ensuring productivity and quality metrics are met.
- May on occasion be required to provide efficient and accurate Part B (or medical drugs) and possibly some Part D drug reviews including, but not limited to high cost and specialty medications. These reviews may support payer preferred drug strategy. If necessary, communication and coordination of the review with the clinical pharmacist or medical director as needed.
- Provide support to quality initiatives that involve medication management for different populations.
- Responsible for documenting and data entry of program activities, member information, notifications, or other administrative materials within the appropriate clinical management systems or reports; may require completion of questionnaires or surveys.
- Participate in various initiatives, meetings, and audits as determined by Apex Health Solutions and its clients. Maintain policies and procedures that support Apex's initiatives and meets State and Federal legal requirements and standards.
- Review and process patient assistance program referral per established protocol.
- Other duties as assigned by leadership team.
- Knowledge of pharmacy operations and drug information.
- Customer service-oriented mindset, motivated problem solver and decision-maker.
- Ability to meet strict deadlines and deliver project results within a specific timeframe.
- Effectively work in a matrix environment to accomplish work across multiple teams in the health plans and health systems.
- Prior experience assisting members and/or providers with inquiries.
- Experience with Windows-based software applications including Word, and Excel.
- Excellent verbal and written communication skills.
- Experience in EMR documentation.
- Working knowledge of PBM systems.
- Must be a team player.
- High School Diploma or Equivalent required.
- An associate or bachelor's degree in health care or health education or a related field
- Two (2) to five (5) years of experience as a pharmacy tech in a retail or community pharmacy setting, health plan, HMO and/or PBM setting.
- Prior experience performing tasks related to medication therapy management or equivalent patient management programs or population health intervention programs.
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Population Health Pharmacy Technician - Houston, United States - Apex Health Solutions
Description
Job Description
Job DescriptionPosition Summary: The Population Health Pharmacy Technician provides support to Pharmacy Operations on activities, projects and initiatives designed to promote the appropriate use of medications - in a population using the VBC paradigm. Assists patients and the physician networks by coordinating prescribed pharmacy care with the patient health care providers, payers, and other health related resources to ensure successful drug therapy outcomes. The activities may include verbal communications with patients, providers offices, and other healthcare practitioners based on the clinical program protocols and workflows. Collaboration with patients, pharmacists, providers, payors, and healthcare staff to reduce treatment gaps and healthcare concerns improving value to patients is required with this position.Essential Duties and Responsibilities
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
In addition to the qualifications below, the qualified candidate must have:
Adaptability - Adapts to changes in the work environment. Manages competing demands. Accepts criticism and feedback. Changes approach or method to best fit the situation.
Communication - Expresses ideas and thoughts verbally. Expresses ideas and thoughts in written form. Exhibits good listening and comprehension. Keeps others adequately informed. Selects and uses appropriate communication methods.
Dependability - Responds to requests for service and assistance. Follows instructions, responds to management direction. Takes responsibility for own actions. Commits to doing the best job possible. Keeps commitments. Meets attendance and punctuality guidelines.
Quality - Demonstrates accuracy and thoroughness. Displays commitment to excellence. Looks for ways to improve and promote quality. Applies feedback to improve performance. Monitors own work to ensure quality.
Quantity - Meets productivity standards. Completes work in timely manner. Strives to increase productivity. Works quickly. Achieves established goals.
Teamwork - Balances team and individual responsibilities. Exhibits objectivity and openness to others' views. Gives and welcomes feedback. Contributes to building a positive team spirit. Puts success of team above own interests.
Education/Experience:
Required:
Supervisory Responsibilities: None
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
