Pharmacy Benefits Coordinator

6 days ago

Minneapolis, Minnesota, United States HealthPartners Full time
Job Title: Pharmacy Navigator

HealthPartners is seeking a highly skilled Pharmacy Navigator to join our team. As a Pharmacy Navigator, you will play a critical role in ensuring our customers receive and understand their pharmacy care and benefit options.

Key Responsibilities:
  • Work with customers, including health plan members, clients, providers, vendors, internal staff, and external providers to resolve issues and provide education on pharmacy benefits and formulary changes.
  • Be available by phone, email, or other means to respond to escalated concerns or consult requests from member services, pharmacy customer service, or pharmacy staff.
  • Document contacts in appropriate systems or databases according to departmental policies.
  • Investigate and work with member rights and appeals around coverage determination challenges.
  • Advocate on behalf of customers for prior authorizations, step therapy, and other plan-related processes.
  • Train member services and pharmacy customer service staff on pharmacy benefits and formulary changes.
  • Analyze pharmacy complaints and inquiries, identify, and advocate for solutions to prevent future occurrences.
  • Apply service recovery according to department policies.
  • Outreach to members to notify them of coverage determinations, proactive communication of complex formulary changes, and medication optimization support.
  • Support pharmacy quality and safety initiatives, such as medication adherence and recalls.
  • Maintain a working knowledge of tools that allow for assistance with formulary status of medications, current benefits, and options available.
  • Support the Medication Management Hub to increase engagement of identified at-risk members.
  • Facilitate coordination of care for at-risk members, including Case Management, Disease Management, MTM, myMailRx Mail Order, Sync my Meds, and Primary Care.
Requirements:
  • Bachelor's degree in a healthcare-related field or equivalent.
  • Pharmacy benefit and medication knowledge.
  • Proficient customer service, care delivery, organizational, and time management skills.
  • Excellent oral, written, and interpersonal communication skills with the ability to establish and maintain working relationships across all levels of the organization.
  • Robust critical thinking, problem-solving, and follow-through skills.
  • Strong interpersonal skills and the ability to engage others.
  • Experienced with computer programs, including Microsoft Office (Word, Excel), Outlook, and Internet-based resources.
  • Self-motivated and able to function independently, taking independent action to facilitate resolution of customers' issues according to departmental procedures.
Preferred Qualifications:
  • Nationally certified pharmacy technician.
  • Pharmacy benefit management or managed care customer service experience.
  • Working knowledge of HealthPartners information systems, benefits, networks, policies, and procedures.
  • Advanced coursework in computer programs, such as Microsoft Office, Internet Explorer, and managed care experience.
About Us:

At HealthPartners, we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're a nonprofit, integrated healthcare organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improves lives around the world.

We're an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, or basis of disability or any other federal, state, or local protected class.

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