Pharmacy Case Manager

We’re looking for a proactive and detail-oriented Pharmacy Case Manager to join our team. In this role, you’ll provide education, information, and assistance to members, pharmacies, and physicians regarding pharmacy benefits. You’ll also collaborate directly with members, physicians, facilities, and manufacturers to coordinate enrollment for patient assistance programs. Additionally, you’ll facilitate care discussions with clinicians, pharmacists, and operational directors to help determine the most cost-effective and clinically appropriate therapies for our members. This is an excellent opportunity to make a meaningful impact by helping members access the care they need while reducing overall costs. At MotivHealth, we’re committed to innovation and excellence, offering competitive benefits, bonus opportunities, professional development, and plenty of perks along the way. HERE’S WHAT YOU’LL DO IN THIS ROLE: Answer inbound pharmacy benefit questions and serve as the primary point of contact for member and physician inquiries. Assist with office duties including intake of faxes, emails, and phone calls. Maintain frequent phone contact with internal staff, external clients, and external pharmacies. Provide support to ensure efficient referral processing from intake through triaging of prescription coverage. Coordinate and facilitate problem resolution for pharmacy and benefit issues. Process patient and prescriber prior authorization requests to ensure timely access to therapy. Utilize established protocols to determine root cause of escalated inquiries and deliver timely resolutions. Manage cases through Patient Assistance Programs to reduce patient and client costs. Independently research and resolve cases using high-level problem-solving skills and sound judgment. Work independently and with the pharmacy team to complete program enrollments, answer inquiries, and coordinate access to therapies in line with policies and procedures. Conduct proactive outreaches for formulary changes and alternate pharmacy options. Keep the savings database updated and accurate. Contribute to a positive, efficient, and safe work environment. Participate in training opportunities and support business needs with other related duties and projects. Consistently work to support and grow the mission, vision, culture, and values of MotivHealth. HERE’S WHAT WE ARE LOOKING FOR: High School Degree/GED required. 2+ years of PBM or pharmacy experience. 2+ years of customer service experience. Prefer Utah State Licensed Pharmacy Technician. Prefer PTCB or ExCPT certified Pharmacy Technician. Knowledge of pharmacy products, programs, delivery channels, and medical terminology. Strong computer skills and proficiency with Microsoft Office. Excellent written and verbal communication skills. Demonstrates a high degree of customer focus and attention to service. Approachable, professional, and dependable work ethic. Ability to thrive in a fast-paced, ever-changing environment. Strong problem-solving and conflict resolution skills. Effective time-management and multitasking abilities. HERE’S WHAT WE OFFER: 5% annual bonus based on company profitability. Affordable health, vision, and dental insurance for you and your family. Company contributes up to $2,300 annually to your Health Savings Account. Wellness program that contributes additional money toward your HSA. Automatic 3% contribution into retirement plan. Career development and growth opportunities. 15 days of PTO & 10 paid holidays per year.