Pharmacy Care Coordinator-exp in prior auth/Specialty Meds
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
- 10 years of experience as a pharmacy technician
- 1 year of experience with specialty medications or direct prior authorization experience
- 1 year of current experience in Diabetes, Cholesterol, Hypertension, Asthma/COPD management
- High-School Diploma or GED
- Pharmacy Technician Certification Board (PTCB) Certification
PREFERRED QUALIFICATIONSPreferred Work Experience
- 15 years as a practicing pharmacy technician
- 5 years of experience as a manager or as a supervisor
- 3 years of experience in the managed care pharmacy field
- 2 years of direct prior authorization experience
- 1 year of experience with formulary and utilization management
- 2 years of experience with Medicare Part D formulary and utilization management
- Bachelor’s Degree
ESSENTIAL job functions AND RESPONSIBILITIES
- Fully develops procedures and policies for operation of staff and facility, including Training. Creates operational execution reports to appropriately track the results
- Creates corrective action plans when desired results are not attained
- Consults with nurses and doctors on pharmaceutical queries.
- Advises on formulary medications as well as innovative types of therapies.
- Maintains clinical knowledge required to hold team accountable
- Works in collaboration with Prior Authorization Supervisor to help with workflows and operational efficiencies
- Collaborate to create clear communication to members and/or providers
- Work in partnership with pharmacy staff to assist in the implementation of utilization management programs
- Educate pharmacy staff on specific utilization management guidelines and processes
- Initiate calls and faxes to the prescriber for the identified members
- Create faxes to request additional information, inform of the next steps and follow up
- Track the ongoing communication and follow up for the desired results
- Work with pharmacists for the clinical review and document in appropriate systems
- With pharmacist assistance, creates pharmacy medication plans
- Provides report on progress on weekly, monthly and quarterly basis
- Creates a comprehensive report of the activities performed
- Opioid Management
- Performs retro review of members on high dosages of opioids and/or taking in combination with benzodiazepines
- Works closely with the prescriber to draft a plan to lower dosage of opioids, benzodiazepines
- Executes plans and track progress
- Educates top opioid prescribers about CDC guidelines on Opioid Prescribing and Medication Assisted Treatment (MAT)
- Management of High Cost Utilizers
- Monitors high cost utilizers on both pharmacy and medical side
- Works with prescribers to do medication reconciliation
- Executes MD plans and track progress
- Works with prescribers to provide other clinically equivalent but cost effective alternatives
- Behavioral Health Management
- Provides medication reconciliation for members utilizing multiple behavioral health medications
- Works with the prescriber to draft a plan to deprescribe unnecessary medications
- Executes plan and track progress
- Works closely with case management to assist members attain their full potential
- Demonstrates the ability to make decisions, take appropriate action and follow tasks through to completion.
- Recognizes and analyzes the implications of new situations and develops workable solutions to maintain productivity and morale.
- Acts as a role model in demonstrating the customer service standards of the Organization.
- Demonstrates a commitment to personal growth and development by participating in external activities related to professional goals.
- Respond cooperatively to managers and staff members in other departments to promote teamwork.
- Attend administrative meetings as appropriate and contribute ideas for improving efficiency, productivity and customer satisfaction.
- Attends all mandatory education and training courses.
- Maintains effective working relationships to ensure teamwork in achieving corporate goals.
- Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
- Coordinates activities between multiple divisions to achieve desired results.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform all other duties as assigned.
Required Job Skills
- Knowledge of utilizing LexiComp, Facts and Comparisons, Micromedex, UptoDate, National guidelines, NCCN etc.
- Proficient in critical literature evaluation skills, including evidence-based medicine principles
- Excellent problem-solving skills
- Strong written and verbal communications.
- Intermediate PC proficiency.
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
- Intermediate skill in word processing, spreadsheet and database software.
- Intermediate skill using departmental BCBSAZ and BCBSA software.
Required Professional Competencies
- Strong organizational and project management skills
- Strong communication skills; must be able to communicate with both internal and external customers while building strategic working relationships
- Flexible skills in an operationally changing environment, with drive for results based on planned objectives.
- Strong customer service skills.
- Interpersonal skills that allow for harmonious relationships with providers, members and coworkers.
- Recognize strategic opportunities and use data to make timely and sound decisions.
- Flexibility and willingness to adjust to shifting demands/priorities
Required Leadership Experience and Competencies
- High standard of performance while pursuing aggressive goals.
- Ability to lead by example.
- Executive presence and cross collaboration across highly functional teams.
Preferred Job Skills
- 1 year experience with drug therapy appeals.
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
- Experience leading plan execution for clinical programs and reporting to executive management progress to strategic goals.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.