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Health Program Associate
2 months ago
The State of Connecticut is committed to providing exceptional healthcare services to our community. As the Department of Social Services, our mission is to enhance the quality of life for all residents by ensuring access to comprehensive and cost-effective healthcare programs.
Responsibilities- Process pharmacy claims, including Prior Authorization, Medical Necessity review, and Pharmacy Client Lock-ins with exceptional accuracy and efficiency.
- Manage and administer Opioid Related prescription treatments with flawless attention to detail.
- Act as the primary contact for providers and members, addressing their healthcare claims and pharmacy access issues promptly and professionally.
- Listen to complaints, identify the root cause of disputes, and effectively resolve the situation, ensuring member satisfaction.
- Organize and sustain ongoing activities for implementing and integrating non-clinical aspects of health programs and projects, contributing to their successful implementation.
- Collaborate with colleagues, share innovative ideas, and maintain flexibility in scheduling to ensure consistent pharmacy coverage.
- Seven (7) years of professional experience in a health organization.
- One (1) year of the General Experience must have been in health care program administration, a health systems agency or other health care organization in at least one of the following areas:
- Grant writing or monitoring;
- Formal program planning, development, management or evaluation;
- Program consultation;
- Public relations activities.
- Knowledge of pharmacy claims processing system including Prior Authorization, Medical Necessity review, and Pharmacy Client Lock-ins.
- Knowledge of Opioid Related prescription treatments.
- Serve as the point person for provider and members for concerns relating to healthcare claims related to pharmacy access issues.
- Ability to listen to complaint and establish where the dispute or problem originates and rectify situation.
- Responsible for providing support in organizing and sustaining on going activities for the implementation and integration of non – clinical aspects of health programs and/or projects.
- Able to collaborate with others, share ideas, and is flexible in scheduling time off to always ensure full pharmacy coverage.
Incumbents in this class may be required to travel.