Prior Authorization Pharmacy Technician
4 weeks ago
General Summary of Position
The pharmacy technician works under the direction of the health plan pharmacists to facilitate the safe and effective use of medications by enrollees/members and their providers. The technician prioritizes the needs of enrollees/members and develops and sustains collaborative professional relationships. Maintains knowledge of and assures departmental compliance with Medstar Family Choice policies, procedures, applicable regulatory requirements, and accreditation standards.
Primary Duties and Responsibilities
Facilitates the accurate and timely processing of medication prior authorization requests.Communicates with patients, providers, and dispensing pharmacies to support medication-related requests and other departmental initiatives.Collects all pertinent information for Medical Reviewers (Medical Directors and Health Plan pharmacists) to complete medication prior authorization clinical evaluation.Supports regulatory requirements under the supervision of the health plan pharmacist. NCQA - Completes letter mailings and other outreach in accordance with NCQA accreditation standards for drug safety recalls, market withdrawals and formulary change notifications. Annotates and prepares audit materials for reaccreditation process. CMS - Reviews monthly retrospective opioid retrospective DUR reports and action outreach in accordance with Federal Regulations. Prepares draft responses of annual CMS Audit report and submits finalized reports prior to deadline. MDH/DHCF -- Prepares and maintains any jurisdiction-specific required audits, reporting, presentations, and/or tracking activities within designated timeframes. Supports ad hoc auditing activities as assigned.Completes delegated Pharmacy and Therapeutics (P&T) Committee activities: drafts presentation content as assigned; creates and records meeting minutes, tracks attendance; drafts meeting minutes for review and approval by Committee Chairperson; communicates meeting-related content to stakeholders; maintains internal formulary tracking database; prepares and posts quarter formulary change summaries; prepares and distributes formulary change notifications for providers and Enrollees/Members.Pharmacy Operations activities. Reviews and finalizes monthly, quarterly and annual PBM reports. Supports maintenance of PA metrics dashboard. Serves as a liaison between MedStar Family Choice and PBM representatives.Supports medication-related initiatives that align with MedStar Family Choice strategic priorities with oversight from the Health Plan Pharmacist. Activities may include but are not limited to outreaching to Enrollees/Members and Providers regarding HEDIS, EQRO, or other quality measures.Completes required regulatory reports that the health plan submits to the regulators.Performs administrative tasks as requested by the Health Plan Pharmacist or departmental leadership.Participates in the ongoing development and expansion of pharmacy initiatives, programs, and continuous process improvement activities. Develops standardized operating procedures and workflows.Supports case management and precertification team to facilitate overridesCreates a pharmacy resource manual for the precertification team.Assists with website content management.Drives member/enrollee centric communications to improve adherence to prescribed therapy.Provides polypharmacy follow-up support for members/enrollees.Required to have availability to provide on-call coverage for pharmacy prior authorization requests received outside of normal business hours on a rotating basis.Acts as Subject Matter Expert to support interdepartmental projects.
Minimum Qualifications
Education
- High School Diploma or GED required and
- Associate's degree preferred
Experience
- 1-2 years Experience as a pharmacy technician in an outpatient dispensing pharmacy required and
- Experience supporting quality improvement goals with focus on HEDIS preferred and
- Previous experience with prior authorization review processes preferred and
- Previous use or knowledge of Cerner or MedConnect preferred and
- Health Literacy Training preferred and
- Health Equity Training preferred and
Licenses and Certifications
- LPT - Licensed Pharmacy Tech Active current pharmacy technician license in good standing in Washington, D.C. required
- Must have DC license required
Knowledge, Skills, and Abilities
- Excellent professional communication
- Advanced organizational skills and attention to detail
- Ability to work in a rapidly changing environment
- Ability to become a subject matter expert (SME) in all pharmacy-related workflows, policies, and procedures
- Energetic personality
- Ability to retain and efficiently disseminate information
- Accurate medication name pronunciation
- Advanced level proficiency with Microsoft Office products (e.g. Word, Excel, SharePoint, Outlook, Teams, etc.)
This position has a hiring range of $19.17 - $33.09
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