Job Description

Location: St. Elizabeth's Medical Center
Posted Date: 12/18/2023
Job Type: See job requirements for other schedule information
Department: 0101.56190 SEH SEHC Pharmacy

Pharmacy Tech (Retail) - full-time 40hrs/wk, dayevening shift, 11a-7:30p/12:30p-9pm Mon-Fri, weekends required as needed.

We are fighting for a healthier world and a new era of wellness!

Nearly a decade ago, we set out to build an entirely different kind of health care company from the ground up—one that unlocks access to affordable, high-quality, and economically sustainable care and wellness in ways never imagined. Today, we are one of the largest private, physician-led health care networks—caring for millions of people across the U.S. Our transformative, fully integrated model represents a new beginning for America’s health care system and others around the world.

We have hospitals across 7 states serving over 800 communities, with more than 43,000 employees. We are ushering in a new day of world class health care. From renowned pediatricians, sports medicine specialists and cardiac surgeons to state-of-the-art hospitals, urgent care centers and medical practices, we can offer easier access to high-quality affordable health care to people nationwide — when they need it and where they want it.

St. Elizabeth’s Medical Center, a Boston University Teaching Hospital, provides patients and families access to some of Boston’s most respected physicians and advanced treatments offering specialized care, including:

  • Advanced Center for Cardiac Surgery
  • da Vinci® Robotic surgery program; Mako Robotic-Arm Assisted Surgery
  • Level III Neonatal Intensive Care Unit (NICU)
  • Award-winning bariatric surgery program
  • Dana-Farber Cancer Institute at St. Elizabeth's Medical Center
  • State-of-the-art emergency care with short wait times

Our medical staff, made up of some of the highest rated physicians in Boston, treats patients in our community practices in neighborhoods, including Allston, Boston, Brighton, Brookline, Newton, Watertown and Weston.

Benefits:

  • Grow with a health system that supports career advancement
  • Competitive Pay & Salary Increases
  • Employee Referral Program
  • Locations close to home, that support work-life balance
  • Affordable Medical, Dental and Vision Coverage
  • 401k via Fidelity, for eligible employees, with company match
  • Tuition Assistance / Reimbursement
  • Family atmosphere and team approach that provides flexibility
  • Opportunities to grow your career, and not change your employer
  • And much more!

Job Summary –

Under the supervision of the Director of Pharmacy in conjunction with the Manager of Clinical-Specialty Pharmacy, is responsible for setting up cases in various applications for drug prior authorization (PA) requests and performs daily quality checks to ensure compliance. Within this role, this person will provide patient care by removing the barriers to medication access. Will work closely with Point 32 Health, which manages PA coding with our Pharmacy Benefit Manger for US Family Health Plan (USFHP) insurance. Will process the formulary changes from the Tricare Beneficiary Advisory Panel minutes for USFHP members and coordinate medication coding updates in conjunction with Point 32 Health to ensure proper formulary drug coding through our PBM. Will be the liaison with clinician offices to facilitate approval of medications through prior authorizations. The coordinator will run claims once authorization is approved and reach out to members and providers as necessary. This role will oversee the daily operations for prior authorization management activities designed to achieve quality and service driven objectives.

Educates and directs Pharmacist and Pharmacy Technicians for all related processes in this workflow.

Qualifications

Minimum Education/Experience:â¯

  • High School Diploma or equivalent required.
  • Must have at least 3 years’ experience with pharmacy and medical prior authorization processes and electronic health records.
  • In addition, must have at least 3 years’ experience working with insurance formularies and coding with pharmacy benefit managers.

Minimum skills/abilities:

  • Knowledge of CPT and ICD coding highly desired
  • Knowledge of third-party payer regulations and guidelines highly desired
  • Proficiency in PC software, especially Microsoft Word and Excel spreadsheet programs
  • Experience with electronic health record systems
  • Ability to effectively manage multiple demands, working under moderate to high degree of pressure
  • Ability to multi-task and problem solve with strong organizational skills.
  • Excellent leadership skills and strong decision making and self-motivation skills.
  • Strong organizational, prioritization, communication, and mathematical skills.
  • Knowledge of Specialty Pharmacy Operations and third-party payers and insurance plans.
  • Ability to understand the importance of and respect the confidentiality of all patient information.

Certification/Licensure

  • BS in Pharmacy or CPhT with an active and in good standing licensure with the MA State Board of Pharmacy. Must meet all requirements for annual Continuing Education Credits.

Job Responsibilities

  • Manage and process formulary drug coding updates in conjunction with Point 32 Health.
  • Manages and optimizes workflows to achieve successful operational and quality outcomes and benefit maximization within the scope of responsibilities.
  • Maintain a current knowledge base related to insurance formulary requirements for prior authorization. Serve as primary resource on prior authorization requirements
  • Directly communicate with Point 32 Health to facilitate the approval of medications in a timely manner through the Pharmacy Benefit Manager, Optum RX.
  • Review prescriptions with provider offices to ensure optimal care of the patient.
  • Navigate pharmacy operation systems to input data, perform adjudication and prepare action plans for follow-up.
  • Able to accurately complete data entry of all new incoming prescriptions for specialty drugs and drugs requiring prior authorizations. This includes calling prescribers to clarify any issues with the dosing and directions.
  • Filling out and sending the correct prior authorization forms to the prescriber and ensuring we have the correct contact information for their office, to complete the prior authorization process without delay.
  • Knowing the formulary of the insurance plan to ensure we are using the most cost-effective options for both the plan and the patients.
  • Provide the prescriber with all the information needed to complete the prior authorization and if applicable give them the insurance preferred alternatives.
  • Requesting clinical notes and lab work when necessary, in addition to the prior authorization forms to ensure the medication prescribed is clinically appropriate and the Clinical-Specialty pharmacist has all the necessary information.
  • Under the supervision of our Clinical-Specialty Team, ensure timely follow-up and processing all prior authorizations for USFHP approving appropriate therapies and denying inappropriate or non-formulary therapies.
  • Contacting prescribers when a non-preferred biosimilar drug is prescribed and if appropriate, having it changed to the preferred.
  • Call patients regarding dose changes, insurance rejections and coverage issues, copay changes and deductibles for all PA and specialty medications.
  • Make arrangements with pharmacy staff to facilitate the appropriate packaging of specialty medications to ensure the contents remain at the proper and stable temperature during the shipping process.
  • Communicate with the post office regarding any issues with lost, delayed, or missing packages to determine if the patient will need an emergency supply sent or a replacement package.
  • Communicate requirements for our PA and Specialty Programs to patients and providers
  • Be the liaison between provider offices and patients to request new prescriptions for specialty medications to ensure the patient does not miss a dose.
  • Facilitate PA approvals to insurances for proper coding to ensure the prescription claim is set up to clear for adjudication with the appropriate co-pay. Facilitate communications to patients, provider offices and infusion centers to assure proper and timely delivery of specialty medications.
  • Identifying coding/copay errors based on the plan formulary so they can be corrected.
  • Communicating with the medical side of the insurance to process prior authorizations needed on the medical side for which we are responsible to provide the medication to the office.
  • Planning the workflow for the PA and Specialty processes which may include enlisting and deploying staff to ensure timely processing.
  • Responsible for knowing when generic medications first become available and their costs from our distributer compared to the brand name so we can adjust insurance coding accordingly.
  • Ordering Specialty Medications when needed and assuring the proper storage of them.
  • Scheduling the delivery of specialty medications to patients directly and to doctor offices or infusion centers.
  • Onboarding new members of the USFHP insurance plan to introduce them to our pharmacy and make certain that they are aware of how the home delivery service works. Since home delivery is the most cost-effective way to provide medications to our members, this individual will obtain all maintenance medications for these members from their providers and set them up for processing.
  • As part of our cost-saving initiatives, this individual will be responsible for working with weekly Excel files to transfer maintenance medications from retail pharmacy locations to be filled by our Home Delivery Service. This is also beneficial to USFHP members as they will pay less in co-pays and get up to a 90-day supply of medication instead of 30 at retail by utilization that service.
  • Assisting the Clinical-Specialty Pharmacy Team by reaching out to patients to increase adherence to maintenance medications.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online