Pharmacy Technician

Are you looking to join a team of like-minded professionals who are passionate about serving Douglas County OHP members, engaging with the community, and delivering outstanding customer service?

At Umpqua Health, we are committed to recruiting top-tier team members who provide exceptional service with professionalism, compassion, and respect for the unique needs of every individual we serve.

If you thrive in a fast-paced, dynamic healthcare environment and are ready to make a meaningful impact, you may be the team member we’re looking for.

We seek individuals who:

• Possess genuine compassion and empathy for our members
• Can adapt to ever-evolving healthcare regulations and requirements
• Are motivated by challenges and dedicated to delivering superior customer service

Join us in serving over 40,000 Douglas County residents as we administer Medicaid benefits and work together to improve health outcomes in our community.

Umpqua Health is a mission-driven, community-focused healthcare organization proudly serving Douglas County, Oregon. Locally owned by CHI Mercy Health and the Douglas County Individual Practice Association (DCIPA), we are deeply rooted in the region and dedicated to improving the health and well‑being of our friends, families, and neighbors.

Umpqua Health is the parent company of Umpqua Health Alliance, one of 16 Oregon coordinated care organizations serving the Oregon Health Plan. The Roseburg-based company and its subsidiaries focus on expanding access, improving care, and reducing unnecessary costs across the clinical space for more than 40,000 Douglas County residents on the Oregon Health Plan and close to 10,000 more individuals with Medicare, private insurance, or Exchange coverage.

• JOB TITLE: Pharmacy Technician I
• REPORTS TO: Director of Pharmacy
• STATUS: FT, Non Exempt
• WAGE RANGE: Wage Band 13 (2024)
• DEPARTMENT: Pharmacy
• WORK LOCATION: Remote (occasional travel as required)

Accountable for supporting medical management functions (utilization management, pharmacy management, and care coordination) with expertise in appropriate areas. Follow Umpqua Health Alliance’s policies and procedures, practice guidelines, state and federal guidelines, and other medical management resources. Serve as liaison to Oregon 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.

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

• 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 time frames.
• 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.

• Assist with Medication Management program…