Pharmacy Patient Advocate Health Plans

Primary City/State: Mesa, Arizona Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Pharmacy Pharmacy careers are better at Banner Health. We are committed to developing the careers of our team members. We care about you, your career today and your future. If you’re looking to leverage your abilities – apply today. As a Pharmacy Patient Advocate Health Plans, you will perform adherence outreach. Experience with Cerner EMR, Excel, Genesys (including autodialing) is preferred for this role. The schedule for this position varies, you can anticipate at least once a week staffing during the weekdays, may need additional coverage for staff absence, weekend overlap (Saturdays), and for other business needs. Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Employee Assistance Program Employee wellness program Discount Entertainment tickets Restaurant/Shopping discounts Auto Purchase Plan Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education) is required. POSITION SUMMARY This position supports the Pharmacy Department in processing pharmacy prior authorization (PA) requests in an accurate and timely manner. Clinical decision making is performed using approved guidelines. Supports the internal and external customers of the Health Plan including members, providers, contracted pharmacies, case managers, medical prior authorization staff, and the customer care staff by addressing issues pertaining to pharmacy and providing pharmacy data as requested. Performs ad hoc reporting on pharmacy claims data as requested. Responsible for performing activities and functions in accordance with policies and procedures under the immediate supervision of a pharmacy technician supervisor, a pharmacist, and/or medical director. CORE FUNCTIONS 1. Processes and finalizes PA requests based on approved guidelines under the supervision of a pharmacist and/or a medical director: entering of PAs into the system and prioritizing requests; checking formulary alternatives, reviewing tried and failed medications; utilizing drug references and verifying the drug being requested is indicated/approved for the condition; documenting all related information regarding the PA approval or non-approval; monitors pending pharmacy prior authorization requests for compliance with regulatory timelines and contacts providers for requested information to avoid out of compliance decisions; respects and maintains highly confidential information as required by HIPAA. 2. Understands the formulary, member cost-sharing, and regulatory requirements, both AHCCCS and Medicare. Assures that pharmacy claims are adjudicating correctly. Maintains compliance with all regulatory requirements. 3. Communicates clearly and accurately with other healthcare professionals including internal personnel as well as individuals external to the organization. Assists internal and external customers with any pharmacy issues, investigates potential causes, and works to resolve issues in an efficient, comprehensive manner. Interacts with the pharmacy benefits management company to resolve any processing errors or system issues. 4. Provides reporting for internal and external customers including, but not limited to, member pharmacy claims history, CSPMP profiles, and pharmacy claims analysis. 5. Participates in the daily review of the Medicare denied claims report. Analyzes the reason for the denied claim and works with the pharmacy to resolve any processing issues. Outreaches to prescriber for prior authorization if indicated. 6. Participates in regulatory oversight including, but not limited to, audits, operational reviews, or ad hoc data requests. 7. Meets established departmental performance metrics for quality and productivity. 8. Works independently under regular supervision. Uses structured work procedures and independent judgment to solve problems and achieve high quality levels. Work output has a significant impact on business goal attainment. Customers include members, pharmacists, providers, non-physician providers, other health care team members, health plan representatives and medical office staff for the purpose of integrating services, improving patient care and ensuring effective communication systems. MINIMUM QUALIFICATIONS Requires pharmacy technician licensure in the state of practice (where applicable). Pharmacy technician certification required. Incumbents in Arizona are also required to provide the AZ Board of Pharmacy Wallet Card at time of hire. Must demonstrate 3 or more years of experience performing pharmacy technician duties in a pharmacy setting with managed care emphasis preferably within a healthcare organization or retail pharmacy. Must have good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts. Must have the ability to learn and master various software programs necessary for job functions PREFERRED QUALIFICATIONS Knowledge of medication management information system software and automated dispensing systems. Previous experience with Medicare, Medicaid or Long Term Care preferred Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: