Clinical Pharmacy Technician Job in Brentwood 37027, Tennessee Us
Clinical Pharmacy Technician
Position Description:
Company: Windsor Management Services, Inc.
Department: Pharmacy
Position reports to: Varies
FLSA Status: Non- Exempt
Pay Basis: Hourly
Classification: Full-time
POSITION DESCRIPTION, DUTIES RESPONSIBILITIES:
• Support Medicare Part D Prior Authorizations and/or Medical Pharmacy Prior Authorizations.
• Support Medicare Part D Call Center questions and issues received from members, pharmacies and providers.
• Answer multiple inbound or outbound calls regarding a member's pharmacy benefits including but not limited to eligibility questions, pharmacy claim questions, prior authorizations questions, billing questions, etc.
• Process approval and denial letters, interact with physicians on all issues, and perform analysis of pharmacy data from claims systems.
• Interact with physicians and pharmacies to initiate coverage determination process or discuss formulary alternatives
• Support all compliance functions as requested.
• Become subject expert with Part D Policy and Procedures.
• Document passing score regarding department assessments.
• Communicate with members and providers regarding the outcome of the coverage determination process.
• Support the Pharmacy Drug Utilization Review program including concurrent, retrospective, and prospective duties.
• Support the Medication Therapy Management and Controlled Substance Monitoring Programs.
• Provide assistance with drug information research, formulary review, and pipeline surveillance data.
• Provide assistance with Medical Management and Case Management programs.
• Support Provider Relations and Pharmacy Support areas to provide quality service to members, providers, and pharmacies.
• Provide support to maintain appropriate clinical, evidence-based criteria required for our Medicare Part D Program.
• Provide assistance with rejected claims, prior authorization loads, invalid provider and transition reports.
• Support Fraud, Waste, Abuse and Compliance programs.
• Support Pharmacy Department Quality programs including STARS.
• May be required to process Coverage Determinations on weekends.
• May be required to access on-call responsibilities after hours and on holidays.
• Additional projects and responsibilities as assigned by department leaders.
EDUCATION/EXPERIENCE REQUIRED:
• Current Certified Pharmacy Technician (Pharmacy Technician Certification Board)
• Minimum of two years experience in a retail pharmacy and strong clinical drug therapy knowledge.
• Part D Health Plan or Pharmacy benefit Management experience preferred.
• Ability to consistently meet deadlines; demonstrated flexibility and ability to work independently and adapt to a changing work environment;
• Excellent planning, time management, and organizational skills
• Team player with a positive attitude.
• Strong professional verbal and written communication skills.
• Basic PC skills required, specifically Microsoft Excel and Word.
• Must be flexible, able to function in a fast paced environment, and able to meet scheduled deadlines and department goals.
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