24 days old

Pharmacy Technician

Umpqua Health

Roseburg, OR 97470

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Job Code

175614215
Jobs Rated

73rd

This job is brought to you by: JobTarget

Full Time - Regular
Roseburg, OR, US

POSITION PURPOSE

Accountable for supporting medical management functions (utilization management, pharmacy management, and care coordination) with expertise in appropriate areas. Follow Umpqua Health Alliances policies and procedures, practice guidelines, state and federal guidelines and regulations, and other medical management resources. Serve as liaison to Oregon Health Plan members, ATRIO Health Plan members, providers, pharmacies, and community healthcare personnel. Works under greater supervision with guidance from more experienced staff, and focuses on performing standard medical management clinical review tasks.

ESSENTIAL JOB RESPONSIBILITIES

Regulatory Compliance:
Maintain updated knowledge of the Oregon Administrative Rules (Medicaid) governing coverage determinations.
Comply with organizations internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.

Utilization Review:
Perform initial review of requests for coverage of pharmacy and medical services. Make decisions in a logical, consistent manner. Provide clear and accurate documentation of the reasoning process for decisions within allotted timeframes.
Effectively navigate and apply the Health Evidence Review Commission Prioritized List of Health Services.
Follow utilization management guidelines with few errors and consistently score 80% or above on inter-rater reliability (IRR) testing.
Evaluate the cost and effectiveness of proposed/delivered services before, during, and after claims payment. Analyze claims data with consideration to medical necessity, the quality of care, and the appropriateness of the delivery of care, and covered benefits.
Utilize applicable resources and systems to prepare materials for pharmacist review, including documentation of key findings, benefit determination, verification of codes and pricing, supporting standards citations, care plans, risk appraisals, and alternative treatment options.
Communicates with providers on formulary or lower cost alternatives, prior authorizations and step therapy guidelines as well as state and federal criteria for services and supplies.
Perform data entry into claims adjudication system with a high level of accuracy.

Care Coordination:
Assist with Medication Therapy Management program daily responsibilities including contacting members, pharmacies, and providers as needed to complete MedSync and assist pharmacist with MTM schedule.
Assist other departments in coordinating medication services for members by answering questions and resolving identified barriers.
Educate members and practitioners about the health plan benefit structure and relevant rights and responsibilities.
As needed, work with the OHP and ATRIO Grievance and Appeals coordinator when they receive calls from a member or the members representative regarding concerns about the care being provided.
Assisting pharmacies as needed to ensure timely dispensing of medications.

Other duties as assigned.

GUIDING BEHAVIORS
Accountability	Always demonstrate the highest performance and behavior standards. Share responsibility and expect others to be accountable.
Efficiency	Demonstrate a proactive approach to problem identification and solutions. Be innovative and solutions oriented improving processes while reducing costs. Demonstrate appropriate time-management skills. Optimize the use of available resources.
Be a Team Player	Support and assist your team members. Be available to help, and learn from your team. Keep an open mind to feedback and earn trust of staff.
Integrity	Keep your promises, commitments, and confidences. Be honest and straightforward dealing with all issues fairly and consistently.
Stewardship	Adhere to all state and federal regulations relating to your position including the Health Insurance Portability and Accountability Act (HIPAA), Fraud & Abuse and Occupational Safety and Health Administration (OSHA) laws. Abide by Company policies and procedures at all times.

CHALLENGES

Working with a variety of personalities, maintaining a consistent and fair communication style.
Satisfying the needs of a fast paced and challenging company.

QUALIFICATIONS

Current National and Oregon Certified Pharmacy Technician (CPhT) licensure.
1+ years' experience as a pharmacy technician.
Managed care experience preferred, but not required.
Fluent in pharmaceutical and medical terminology.
Proficient PC navigational, MS Office (Word, Excel, Outlook), data entry, and internet research skills required.
Ability to provide excellent customer service to internal and external customers.
Effective written, verbal, and interpersonal communication skills.
Ability to effectively collaborate with others and function as a part of a highly functioning team.
Excellent self-discipline to meet deadlines and follow policies, procedures, and workflows in a remote environment.
Excellent critical thinking and time management skills required to organize and prioritize workload according to goals and specified turnaround times.
Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently.

PHYSICAL DEMANDS

Typical office environment requiring standing, sitting, walking, bending, and lifting up to 25 pounds. May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases.

PI175614215

Jobs Rated Reports for Pharmacy Technician

Posted: 2022-04-28 Expires: 2022-05-29

Umpqua Health

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