Pharmacy Navigator Technician – Managed Care, PBM

Job not on LinkedIn

🕒 April 29

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Assisting the pharmacist with Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution. • Outbound phone calls to members, prescribers, and/or pharmacies to ensure member satisfaction. • Demonstrate compassion and care, optimize the customer experience, and provide professional member support and service. • Serves as a liaison between internal departments (such as care management, member services). • Makes outbound calls and receives calls from both provider/physician’s offices and pharmacies. • 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. • 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. • Document and record services/activities in appropriate databases/software to ensure compliance with CMS regulations.

🎯 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

• Ability to stand and walk short distances for eight or more hours. • Frequent bending, stooping, or stretching. • Ability to lift 30 pounds and push 50 pounds.