Health Plan Pharmacy Technician

General Summary of Position

The Health Plan Pharmacy Technician works closely with the Clinical Pharmacists and Medical Directors to facilitate the safe and effective use of medications by MedStar Family Choice members and their providers. The technician makes members and their needs a primary focus of one's actions; develops and sustains productive member relationships, maintains knowledge of and assures departmental compliance with Medstar Family Choice's policies and procedures and applicable regulatory requirements and accreditation standards.

Primary Duties and Responsibilities

• Facilitates the approval or denial of medication prior authorization requests from members and providers in a timely manner. Responsible for making outbound/receiving inbound calls and speaking with providers' offices for additional information or clarifications needed to process the prior authorization request.
• Provides the Clinical Pharmacist or Medical Director reviewing each request with all necessary clinical information to render an appropriate decision.
• Adheres to MedStar Family Choice prior authorization requirements as stipulated by the department.
• Cultivates relationships with providers and their staff to facilitate rapid resolutions to all requests.
• Works closely with the Clinical Pharmacists as well as the quality team to identify HEDIS targets that can be impacted by the pharmacy team.
• Makes appropriate outreach to members and providers regarding the HEDIS measure.
• Tracks progress making regular reports to the Clinical Pharmacist and Chief Medical Officer or designee.
• Maintains and updates internal pharmacy databases. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis.
• Assists in the preparation of monthly pharmacy formulary updates for State regulator.
• Receives monthly Corrective managed care file from State regulator and performs reconciliation of State regulator and MFC data assist in preparation of monthly Corrective Managed Care reconciliation report to State regulator.
• Other duties as assigned

Minimal Qualifications
Education

• High School Diploma or GED required
• Associate's degree preferred
• Graduation from a hospital-based or community college technician training program preferred

Experience

• 1-2 years experiences as a Pharmacy Technician with 1 year in a Specialty Pharmacy or Hospital pharmacy environment preferred

Licenses and Certifications

• National pharmacy technician license EXCPT or PTCB required upon hire
• Maryland pharmacy technician license required upon hire