Pharmacy Care Navigator

4 weeks ago

IL United States Cityblock Full time
About the Role

As a Pharmacy Care Navigator at Cityblock, you will play a critical role in minimizing gaps in treatment and eliminating barriers to medication adherence. You will collaborate with comprehensive interdisciplinary teams to provide members with medication reconciliation, access, adherence, and affordability services. Your expertise will help identify and communicate discrepancies to build long-term solutions.

Responsibilities
  • Medication Access and Adherence: Serve as the pharmacy team's first line of triage and subject matter expert for medication access, adherence, and affordability needs, including prior authorizations, PA appeals, copay assistance, and rx billing issues.
  • Medication Formularies and Network Pharmacies: Assist in the upkeep of market-specific medication formularies and network pharmacies.
  • Care Team Education: Provide ongoing education to care teams on medication access, adherence, and affordability tools and resources.
  • Member Eligibility and Screening: Proactively screen disease state registries, medication adherence reports, and incoming referrals from care teams to confirm member eligibility for the clinical pharmacy program.
  • Scheduling and Communication: Schedule members referred or identified as eligible for initial pharmacist consult visits, perform reminder phone calls, and appointment rescheduling as necessary.
  • Medication List Verification: Assist with verifying medication list details, alerting the pharmacist of discrepancies as per clinical protocol.
  • Pharmacist Correspondence and Communication: Facilitate sending of pharmacist correspondence and communications to external prescribers and outside pharmacies for loop closure.
  • Quality Initiatives and Medication Safety: Participate in market-specific quality initiatives (HEDIS/Stars) to support positive clinical outcomes and drive down utilization cost, and participate in medication safety projects, assist in identifying drug shortages, and develop internal management plans/memos.
Requirements for the Role
  • Education and Certifications: Associates Degree and CPharmacy Technician Certificate from PTCB.
  • Experience: Minimum 6 years of experience as a pharmacy technician in a retail and/or outpatient pharmacy.
  • Technical Skills: Experience with EHR, G Suite, email, slack, etc.
  • Medical Terminology: Prior experience with and knowledge of medical terminology, ICD-10/CPT codes, third-party billing resolution, including Medicaid/Medicare/dual, prior knowledge of pharmacy insurance prior authorization process, and experience with medications.
  • Independent Self-Starter: You are an independent self-starter and a strategic thinker who is eager to learn, improve, grow, and demonstrate applied learning.

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