Pharmacy Navigator Technician – Managed Care/PBM

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Peak Health is hiring a Pharmacy Navigator Technician. The Pharmacy Navigator Technician is primarily responsible for assisting the pharmacist with Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution. This position is responsible for outbound phone calls to members, prescribers, and/or pharmacies to ensure member satisfaction, demonstrate compassion and care, optimize the customer experience, and provide professional member support and service. To be considered for this role, you must hold a valid Pharmacy Technician license in West Virginia. This is an excellent opportunity for a compassionate pharmacy professional who enjoys both problem-solving work and patient/provider interaction.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or Equivalent.

2. Must possess current licensure as required by state board where services will be provided: WV: Pharmacy Technician License or Trainee License through West Virginia Board of Pharmacy.

3. Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Health career Association (NHA)"High School diploma or equivalent.

EXPERIENCE:

1. Two (2) years of experience specific to Medicare Part D.

2. Two (2) years of Pharmacy Technician or healthcare related experience.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Associates degree OR Post high school education in a science field of study OR graduate of a pharmacy technician training program.

2. Experience utilizing Electronic Medical Records, such as EPIC.

3. Experience with Pharmacy Benefit Manager (PBM).

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Serves as a liaison between internal departments (such as care management, member services) to provide best-in-class care to enrollees and aid in issue resolution.

2. Makes outbound calls, receives, and responds to calls from both provider/physician’s offices and pharmacies if necessary.

3. Execution of ‘white-glove’ processes to ease member transitions from formulary disruptions, pharmacy network changes, etc.

4. Ensure compliance with all regulatory guidelines, including but not limited to ERISA and CMS.

5. Aligns with the goals, metrics, and ongoing strategy to support quality initiatives and to ensure members remain adherent to maintenance medication therapies.

6. Collaborate with healthcare professionals to discuss patient care plans and medication needs.

7. Provide information and education to patients regarding pharmacy network, formulary, and patient care programs.

8. Stay updated on medical terminology and best practices related to medication utilization.

9. Adhere to member outreach initiatives to optimize clinical quality and close healthcare gaps.

10. Provides patient-centered care that will improve clinical outcomes and reduce total cost of care.

11. Follow up with clinics, providers, pharmacies, and health plan beneficiaries to resolve issues and concerns promptly.

12. Foster ongoing relationships with providers, members, and various internal departments to ensure members are receiving appropriate care.

13. Document and record services/activities in appropriate databases/software to ensure compliance with CMS regulations.

14. Refer members as appropriate to Peak Health Plan and/or WVU programs for coordination of care.

PHYSICAL REQUIREMENTS: 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.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping, or stretching.

3. Ability to lift 30 pounds and push 50 pounds.

WORKING 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.

1. Standard office environment.

2. Some travel may be required to provider offices and offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work cooperatively as a team member with articulate oral and written communication and presentation skills.

4. Ability to work in a fast-paced and rapidly changing environment with attention to detail.

5. Ability to work proactively and independently to research and resolve complex issues.

6. Experience with regulatory and accreditation standards.

7. Ability to apply relevant laws, regulations, requirements, and policy standards.

8. Extensive working knowledge of Microsoft Office applications including Excel, Outlook, PowerPoint, Teams, electronic medical records, and MTM platforms.

9. Must be able to communicate effectively verbally and in writing and place high emphasis on customer service. 

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2405 PHH Medication Management