Pharmacy Care Specialist

3 weeks ago

Nashville, Tennessee, United States Elevance Health Full time

About Us:

Elevance Health is a leading health company dedicated to improving lives and communities through innovative pharmacy care solutions. We are a Fortune 25 company with a rich history in the healthcare industry, seeking passionate leaders to join our team and make a meaningful impact on our members and communities.

Job Overview:

We are currently seeking a highly skilled and motivated Pharmacy Technician II to join our team in a virtual setting. As a Pharmacy Care Specialist, you will be responsible for interpreting and processing moderately complex prescriptions, prior authorization requests, and troubleshooting adjudication issues. Your expertise will play a vital role in ensuring the highest level of pharmacy care for our members.

Key Responsibilities:

  1. Verify member information and accurately input data for pharmacists.
  2. Educate members on pharmacy-based rules and resources related to prescriptions and medication assistance programs.
  3. Process prior authorization requests from physicians' offices and ensure compliance, informing relevant parties of all determinations.
  4. Provide resolution to grievances and appeals issues.
  5. Respond to inquiries from physicians, sales teams, and members regarding formulary and prescription benefits.
  6. Generate reports on rebates, physician utilization, Beers Criteria, Reliance members, and other ad-hoc reports.
  7. Maintain accurate records of prior authorizations, rebates, and monthly reports.

Requirements:

To be successful in this role, you will need:

  1. An active, professional license, if required by state law, and state pharmacy technician certification or national certification based on applicable state requirements.
  2. A high school diploma or equivalent and a minimum of 2 years of pharmacy experience; or any combination of education and experience providing equivalent background.

Preferred Qualifications:

The ideal candidate will possess:

  1. Excellent communication skills with commercial members.
  2. Call center experience with high call volumes.
  3. Experience in discussing medication adherence.
  4. Proficiency in computer systems and multitasking.
  5. Patient care experience.

What We Offer:

Elevance Health offers a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

About Our Culture:

We are creating a culture that advances our strategy and leads to personal and professional growth for our associates. Our values and behaviors are the root of our culture, driving our shared success for our consumers, associates, communities, and business.

Location:

This role will be based in a virtual setting, with the ideal candidate residing within 50 miles or a 1-hour commute each way of a relevant Elevance Health location.

Estimated Salary:

$55,000 - $65,000 per year, depending on location and experience.

Benefits:

Elevance Health offers a comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

How to Apply:

If you are a motivated and passionate pharmacy professional looking to make a meaningful impact, please submit your application for consideration. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected status.

Note:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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