Pharmacy Care Coordinator

Responsibilities:

 

·        Act as a clinical and operational liaison of the Fund’s Rx benefit between 1199SEIU Benefit Fund members, providers, Utilization Management (UM)vendors, and pharmacies

·        Access Fund’s UM vendor system in the Medical Benefit Drug Management Program to access and download report of medical drug UM cases

·        Access Fund’s UM vendor system in the Medical Oncology Program to access and download provider, member, or facility site UM letters of medical oncology cases

·        Access the Fund’s PBM system to access prescription drug and appeals information

·        Utilize the Document Management System (DMS) Rx module to prepare, organize and maintain prescription drug inquiries received by fax from providers or members or other Fund Departments

·        Monitor, screen and respond to incoming emails from Fund Departments to resolve escalated Rx benefit issues by close of business day

·        Prepare Rx utilization forms in the DMS module and gather clinical documents by accessing UM vendor systems and researching past clinical authorizations

·        Prepare physician UM benefit determination letters and appeal communications of prescription drug inquiries

·        Fax provider communications of prescription drug clinical reviews through a secure method that is HIPAA compliant

·        Verify member eligibility status and eligibility class in Vitech (V3), where applicable

·        Enter notes in claims processing system (QNXT) of prescription drug inquiries, provider inquiries, and appeals

·        Post Bulletin Board notices and contribute to BeneFAQs topics related to the Rx benefit

·        Assist in maintaining the accuracy of the drug benefit content of the Fund’s website by working with Digital Communications

·        Perform special projects and assignments as directed by management

 

Qualifications:

·        Associate’s Degree required. Bachelor’s Degree or Pharmacy Technician Certification (CPhT) preferred

·        Minimum of one (1) years prior work experience in a health care setting such as: retail or mail order pharmacy, physician’s office, outpatient medical facility, Pharmacy Benefits Manager ( PBM) DME supplier or Prior Authorization (PA) Call Center is required

·        Bilingual language skills are a plus

·        Excellent knowledge of the Fund pharmacy and medical drug benefits, eligibility rules and regulations