Pharmacy Coordinator-NDC (774151)

Minimum Qualifications

• Possess an Associate’s Degree in a health related field (i.e., Medical Assistant) or a certification as a Pharmacy Technician
• Have experience working for a Pharmacy Benefit Management (PBM) company or health plan in a managed care pharmacy department; working knowledge of retail pharmacy third party prescription processing.
• Have knowledge of drug categories, brand and generic names including pronunciation and spelling; knowledge of utilization management tools used for controlling pharmacy costs – i.e. quantity limits, prior authorization, step therapy, generic programs, etc.
• Ability to have a professional dialogue with a physician or a physician’s staff.
• Basic computer skills to include, but not limited to, Microsoft Office Products.

Role Description:

Description of Work/Duties:Consultant in this position will be responsible for receiving and processing drug prior authorization requests for the Pharmacy Program of the Department of Human Services, Office of Medical Assistance Program’s Bureau of Fee-For-Service (FFS). Consultant will:

1. Be available as a full time consultant approximately 37.5 hours per week on an in-determinant basis;

2. Hold an Associate Degree in a healthcare-related field, i.e. Medical Assistant or a certification as a Pharmacy Technician; or

3. Have experience working for a Pharmacy Benefit Management (PBM) company or health plan in a managed care pharmacy department;

4. Have a working knowledge of retail pharmacy third party prescription processing;

5. Have knowledge of drug categories, brand and generic names including pronunciation and spelling;

6. Have knowledge of utilization management tools used for controlling pharmacy costs – i.e. quantity limits, prior authorization, step therapy, generic programs, etc;

7. Have the ability to have a professional dialogue with a physician or a physician’s staff;

8. Possess basic Microsoft Office skills;

9. Have effective verbal and telephonic skills;

10. Possess excellent organization, planning, communications, and interpersonal skills;

The principal accountabilities include:

1. Process prior authorization requests. Issue prior authorizations as appropriate through established protocols, policies and procedures. Communicate with the physicians and pharmacies approvals and denials by phone and/or letter as needed.

2. Answer questions/requests and resolve issues from providers, pharmacists and staff. The incumbent will field questions regarding pharmacy benefit issues and communicate details of service through telephonic responses to physicians, pharmacists and Commonwealth staff. Issues addressed include prescription benefits, formulary issues, prescription claim processing, and prior authorizations. The incumbent ensures documentation of actions.

3. Resolve routine provider pharmacy concerns. This includes answering questions from various sources (a member, physician, staff, etc) regarding specific provider issues and as appropriate deciding on plans of action to resolve routine issues.

4. Provide administrative support to the pharmacy team. This involves preparation and distribution of Policies & Procedures, committee agendas and minutes, and other correspondence as required.

5. Document all communications appropriately. This includes documentation through DPW’s telephone call tracking system.

Other Accountabilities:

1. Maintain current information regarding pharmacy benefits and all pharmacy reference material.

2. Assist the Director or Project Manager in projects, reviews, mailings and all other matters relevant to the pharmacy benefit.

3. Participate in team meetings and any other committees as deemed appropriate by the Director

4. Assist in the preparation and distribution of Quarterly Utilization Reviews

5. Assist in the preparation and distribution of Preferred Drug Lists and periodic updates to providers.

6. Assist in the preparation of any pharmacy related educational programs

7. Perform other duties and assignments as directed by the Director/Supervisor.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com