Certified Pharmacy Technician - Jefferson Health Plan

Job Details

Works under general supervision and answers calls from physician and pharmacy providers through pharmacy hotline. Assist in administering prior authorizations according to established guidelines and assists Clinical Pharmacists in case review process. Actively participate in physician education and outreach program and perform claims analysis for drug utilization review (DUR), fraud, abuse, and over-utilization.

Works under general supervision and answers calls from physician and pharmacy providers through pharmacy hotline. Assist in administering prior authorizations according to established guidelines and assists Clinical Pharmacists in case review process. Actively participate in physician education and outreach program and perform claims analysis for drug utilization review (DUR), fraud, abuse, and over-utilization.

• Able to work in a constant state of alertness and safe manner.
• Assist department in reaching call center goals based on standards of productivity (percent of calls answered within 30 seconds, percent of abandoned calls).
• Assist department in reaching call center goals based on standards of quality (providing accurate information to physicians and pharmacies).
• Maintain knowledge of different pharmacy benefit packages under Medicaid and Medicare to be communicated to providers and other departments.
• Assist Clinical Pharmacists in responding to physician and pharmacy providers’ telephone calls, to provide safe and effective formulary alternatives, resolve processing errors (i.e. eligibility, plans limits exceeded, national drug code (NDC) not covered, refill too soon, etc.).
• Assist Clinical Pharmacists in reviewing clinical cases including researching previous medication history, obtaining additional information as it pertains to the case, notifying physician’s office of approval and/or denial of prior authorization request, generating letters for approved medication requests, and expedite prior authorization requests.
• Interact with other departments including Member Relations, Special Needs Unit, Complaints and Grievances, Disease Management, and Utilization Management; assisting in resolving pharmacy issues.
• Conduct clinical DUR on pharmacy claims and make recommendations for recipient restriction program.
• Provide ideas and suggestions to help improve quality and flow of pharmacy department.
• May perform other duties as assigned.

• High School Diploma/GED
• 1 year of’ experience in pharmacy.
• Familiar with a managed care and delegated pharmacy services
• Excellent written and oral communication skills
• Self-motivated and a team player.
• Proficient in Excel and relational databases such as MHS, CIC, DST, Macess
• CPhT
  - Certified Pharmacy Technician
  - Pharmacy Technician Certification Board

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use,
* patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Workday Day (United States of America) Worker Sub Type Regular Employee Entity Health Partners Plans, Inc.

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers;

and creating new knowledge through basic/programmatic, clinical…