Peak Health
Managed Care/PBM
PharmacyNavigatorTechnician–ManagedCare/PBM
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Pharmacy Navigator Technician – Managed Care/PBM at Peak Health. Skills: Pharmacy Technician, Customer Service, Issue Resolution, Medicare Part D, Regulatory Compliance. Assisting the pharmacist with Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution. Making outbound phone calls to members, prescribers, and/or pharmacies”
What You'll Achieve.
Ensure member satisfaction; Optimize the customer experience; Provide professional member support and service; Ensure members remain adherent to maintenance medication therapies; Improve clinical outcomes; Reduce total cost of care; Resolve issues and concerns promptly; Ensure members are receiving appropriate care; Ensure compliance with CMS regulations
Industry & Context.
Issue resolution; Ability to work proactively and independently to research and resolve complex issues
Ability to stand and walk short distances for eight or more hours, Frequent bending, stooping, or stretching, Ability to lift 30 pounds and push 50 pounds, Some travel may be required to provider offices and offsite meetings
What They're Looking For.
Must Have
Pharmacy Technician license in West Virginia, High school diploma or Equivalent, Current licensure as required by state board where services will be provided: WV: Pharmacy Technician License or Trainee License through West Virginia Board of Pharmacy, Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Health career Association (NHA), Two (2) years of experience specific to Medicare Part D, Two (2) years of Pharmacy Technician or healthcare related experience
Nice to Have
Associates degree OR Post high school education in a science field of study OR graduate of a pharmacy technician training program, Experience utilizing Electronic Medical Records, such as EPIC, Experience with Pharmacy Benefit Manager (PBM)
What You'll Do.
Assisting the pharmacist with Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution
Making outbound phone calls to members
Serving as a liaison between internal departments
Making outbound calls
and responding to calls from both provider/physician’s offices and pharmacies
Executing ‘white-glove’ processes to ease member transitions
Ensuring compliance with all regulatory guidelines
and ongoing strategy to support quality initiatives
Collaborating with healthcare professionals to discuss patient care plans and medication needs
Providing information and education to patients regarding pharmacy network
and patient care programs
Staying updated on medical terminology and best practices
Adhering to member outreach initiatives
Providing patient-centered care
Following up with clinics
and health plan beneficiaries to resolve issues and concerns promptly
Fostering ongoing relationships with providers
and various internal departments
Documenting and recording services/activities in appropriate databases/software
Referring members as appropriate to Peak Health Plan and/or WVU programs for coordination of care
How You'll Work.
Team & Collaboration
Serves as a liaison between internal departments (such as care management, member services); Collaborate with healthcare professionals to discuss patient care plans and medication needs; Foster ongoing relationships with providers, members, and various internal departments; Ability to work cooperatively as a team member
Communication Scope
Articulate oral and written communication and presentation skills; Must be able to communicate effectively verbally and in writing
Full Job Description
## Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Peak Health is hiring a Pharmacy Navigator Technician. The Pharmacy Navigator Technician is primarily responsible for assisting the pharmacist with Commercial and Medicare Advantage pharmacy coverage and benefits customer service inquiries and issue resolution. This position is responsible for outbound phone calls to members, prescribers, and/or pharmacies to ensure member satisfaction, demonstrate compassion and care, optimize the customer experience, and provide professional member support and service. To be considered for this role, you must hold a valid Pharmacy Technician license in West Virginia. This is an excellent opportunity for a compassionate pharmacy professional who enjoys both problem-solving work and patient/provider interaction. **_MINIMUM QUALIFICATIONS_****:** **EDUCATION, CERTIFICATION, AND/OR LICENSURE:** 1\. High school diploma or Equivalent. 2\. Must possess current licensure as required by state board where services will be provided: **WV:** Pharmacy Technician License or Trainee License through West Virginia Board of Pharmacy. 3\. Nationally Certified Pharmacy Technician through Pharmacy Technician Certification Board (PTCB) or National Health career Association (NHA) **EXPERIENCE:** 1\. Two (2) years of experience specific to Medicare Part D. 2\. Two (2) years of Pharmacy Technician or healthcare related experience. **_PREFERRED QUALIFICATIONS_****:** **EXPERIENCE:** 1\. Associates degree OR Post high school education in a science field of study OR graduate of a pharmacy technician training program. 2\. Experience utilizing Electronic Medical Records, such as EPIC. 3\. Experience with Pharmacy Benefit Manager (PBM). **CORE DUTIES AND RESPONSIBILITIES:** The statements describ
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