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Pharmacy Technician III- Escalations

4 months ago

Grand Prairie, United States Elevance Health Full time

Pharmacy Technician III- Escalations (Pharmacy Tech III Dispensing)

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles within our Mason, OH, Grand Prairie, TX, Chandler, AZ, or Tucson, AZ, PulsePoint locations.

CarelonRx Pharmacy is now part of CarelonRx (formerly IngenioRx), a proud member of the Elevance Health family of companies. The CarelonRx Home Delivery Pharmacy will deliver digital first pharmacy experience that is convenient, simpler to use, and more affordable to patients and payers. Our Pharmacy model focuses on whole person care, providing the best member experience to drive adherence, affordability, and improved overall health outcomes by putting the patient first.

The Pharmacy Technician III- Escalations will perform all pharmacy technician duties under the regulatory authority of the state they are practicing in and aid in the dispensing of prescriptions to patients by the CarelonRx Pharmacist. Responsible for complex pharmacy, patient, and prescriber encounters, including, but not limited to prescription claim adjudication exceptions, returns, reships, drug recalls, and patient and prescriber escalations.

How you will make an impact:

  • Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs.

  • Serves as the subject matter expert, proactively manages service failures and workflow in our contact center tool and our prescription processing system.

  • Partner and support pharmacists in the performance of their duties, including outreach to patients and prescribers for resolution on open issues.

  • Processes prior authorization requests from physicians and ensures compliance with all regulatory requirements; informs relevant parties of all prior authorization determinations.

  • Provides resolution to grievances and appeals issues.

  • Managing inbound and outbound communications, triaging and problem-solving pharmacy inquiries, ensuring any related patient and prescriber communication is completed and resolving all related open cases across patient services tool and pharmacy processing system, and managing prescription queue workflow.

  • Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.

  • Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports.

  • Mentor and train lower-level pharmacy technicians as needed; as well as lead pharmacy technicians working prescription queue-based assignments to ensure quality, meeting turnaround times, and delivering on patient, prescriber, and client experience and expectations.

  • Collaborates with account management and client facing partners to resolve Escalations that occur in the normal operations of the Pharmacy. This may include working with patients, providers, and internal business partners to ensure Client and Patient issues are resolved.

Minimum Requirements:

  • Requires H.S. diploma or equivalent and minimum of 5 years of pharmacy experience.

  • Requires an active, professional license, if required by state law(s), State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.

  • Experience with PBM/Plan insurance setup and processing and claims adjudication and resolution of reject messaging required.

Preferred Skills, Capabilities, and Experiences:

  • Experience with EnterpriseRx, Patient Services Tool, and COS preferred.

For URAC accredited areas, the following professional competencies strongly preferred: strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.