Pharmacy Navigator Technician – Managed Care, PBM

🕒 April 30

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• 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. • Makes outbound calls, receives, and responds to calls from both provider/physician’s offices and pharmacies if necessary. • Execution of ‘white-glove’ processes to ease member transitions from formulary disruptions, pharmacy network changes, etc. • Ensure compliance with all regulatory guidelines, including but not limited to ERISA and CMS. • Aligns with the goals, metrics, and ongoing strategy to support quality initiatives and to ensure members remain adherent to maintenance medication therapies. • Collaborate with healthcare professionals to discuss patient care plans and medication needs. • Provide information and education to patients regarding pharmacy network, formulary, and patient care programs. • Stay updated on medical terminology and best practices related to medication utilization. • Adhere to member outreach initiatives to optimize clinical quality and close healthcare gaps. • Provides patient-centered care that will improve clinical outcomes and reduce total cost of care. • Follow up with clinics, providers, pharmacies, and health plan beneficiaries to resolve issues and concerns promptly. • Foster ongoing relationships with providers, members, and various internal departments to ensure members are receiving appropriate care. • Document and record services/activities in appropriate databases/software to ensure compliance with CMS regulations. • Refer members as appropriate to Peak Health Plan and/or WVU programs for coordination of care.

🎯 Requirements

• High school diploma or Equivalent. • 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. • Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Health career Association (NHA) • Two (2) years of experience specific to Medicare Part D. • Two (2) years of Pharmacy Technician or healthcare related experience. • Associates degree OR Post high school education in a science field of study OR graduate of a pharmacy technician training program. • Experience utilizing Electronic Medical Records, such as EPIC. • Experience with Pharmacy Benefit Manager (PBM).

🏖️ Benefits

• Standard office environment • Some travel may be required to provider offices and offsite meetings