Pharmacy Technician

Glen Allen VA 23060 Suite 500

Job Description

Magellan Health is the leader in managing complex population health, concentrating on all areas across healthcare and pharmaceutical management. At Magellan Health, 10,000 people wake up every day determined to help our members. We do this by connecting behavioral, physical, pharmacy and social needs into a complete picture of care that’s personalized, coordinated and cost-effective. By turning fragmented care into focused care, we empower 1 in 10 Americans to lead healthier, more vibrant lives.
Magellan Rx Management is a next-generation, full-service pharmacy benefit manager (PBM) that moves beyond the basic services to help our customers and members solve complex pharmacy challenges. We do this by connecting them to the people, technology and information they need to make smarter healthcare decisions. As experts in pharmacy management, we discover new and better ways to help clients manage the rising cost of specialty medications, ensure members adhere to their medications, and provide prescribers access to the resources they need to make more informed health decisions for their patients.
This is an exciting opportunity for a Certified Pharmacy Technician to work in a complex, high impact customer service role for our Member Services department. The Pharmacy Technician accepts incoming calls related to requests and resolves issues that have been submitted via phone and fax, and partners with other departments to ensure timely resolution of requests/inquiries, which include: Pharmacy, Shipping, Customer Care, Finance, Claims Processing, and Eligibility. This position may work in multiple types of queues and databases to resolve issues. This position also involves extensive phone interactions with members and possibly Prescribers as well. Technicians will serve as the initial point of contact for Customer Care Associates and Members before the required Pharmacist involvement for all clinical issues/questions.

This role is both challenging and rewarding. You’ll need to work within multiple computer systems simultaneously as you respond to questions or provide specific medication details / clinical information. It’s a fast paced, high volume environment where our members are counting on us to deliver these important, sometimes life - saving medications in an accurate and efficient manner.
  • The Pharmacy Technician is responsible for evaluating and authorizing approval of prior authorization pharmacy requests from prescribers received by telephone and/or fax using client criteria. Primary duties may include, but not limited to:

  • Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
  • Researches, resolves and documents prior authorization outcomes in pharmacy system.
  • Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
  • Verifies member information and inputs data for the pharmacists.
  • Educates members on pharmacy based rules related to prescriptions and medication resources or assistance programs.
  • Processes prior authorization requests from physicians’ offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations.
  • Provides resolution to grievances and appeals issues.
  • Maintains record keeping of prior authorizations, rebates, and monthly reports.
  • Requirements:

  • Requires High School diploma or GED, and 2 years of pharmacy experience.
  • Current National Certification and State Pharmacy Tech Certification based on applicable state(s) are required. In the states of Florida, Rhode Island and Michigan, license registration with the Board of Pharmacy is required without exception. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the PTCB.
  • In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
  • Proficiency in Pharmacy computerized systems and software applications, as well as Windows-based applications and MS Office Product Suite.
  • Excellent written and verbal communication skills.
  • Ability to follow clinical criteria and instructions to approve prior authorization requests.
  • Preferred Qualifications

  • Prior call center experience strongly preferred.
  • Medical terminology training, pharmaceutical terminology experience and/or experience in medical, insurance or pharmaceutical field are preferred.
  • Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
  • Advanced verbal and written communication skills
  • Team-oriented, customer service focused, and able to identify process improvements
  • Responsive, reliable and able to express assurance/confidence
  • Demonstrate strong research skills with the ability to evaluate, focus on the problem and find the resolution.
  • Understand the importance of timely work and effective planning.
  • Prioritizing and organizing workload in adherence to deadlines.
  • Desire and aptitude to assist a customer with escalated concerns and provide final resolutions.
  • Ability to respond to escalated concerns in a calm and professional manner in attempts to prevent further escalations.
  • Ability to multi-task with strong time management skills.

General Job Information

Title

Pharmacy Technician

Grade

17

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

10/11/2019

Date Requisition Created

10/11/2019

Work Experience

Pharmacy

Education

GED (Required), High School (Required)

License and Certifications - Required

CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • CPT:  Certification/licensure in accordance with state requirements. In the states of Florida, Rhode Island and Michigan, license registration with the Board of Pharmacy is required without exception.
  • PTCB:  Certification or the ability to obtain PTCB Certification within one year of hire. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the PTCB.
  • Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
  • In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
  • Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
  • Excellent written and verbal communication skills.
  • Ability to follow clinical criteria and instructions to approve prior authorization requests.
  • Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
  • Ability to identify and trouble-shoot problematic issues.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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