Job Description

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose:

The Pharmacy Technician Lead oversees and performs the processing of service requests received from providers for Health Choice members. The Pharmacy Technician Lead ensures requests for services are processed within established timeframes, and in accordance with Steward Health Choice criteria and guidelines. This position requires strong communication, leadership, and organizational skills to assist pharmacy technicians, and Pharmacy Supervisor provide quality pharmacy outcomes for Steward Health Choice members and providers. This position requires a specialized training and knowledge base for the prompt and accurate processing of pharmacy service requests. This position also assists the Pharmacy Quality Manager by making outbound calls to members, providers and pharmacies to improve quality of care and solve medication related problems.

Assist Pharmacy Technician Supervisor with staffing oversight and management responsibilities.

  • Serve as a pharmacy technician staff resource.
  • Develop and maintain training materials for pharmacy prior authorization processes.
  • Train new staff and work with existing staff to improve job performance (cross training and refresher training).
  • Audit training effectiveness and staff competencies.
  • Update desktops on pharmacy technician processes.

Conduct pharmacy coverage determinations activities accurately, effectively and efficiently within the appropriate time frames.

  • Review requests based on current medication formulary and Steward Health Choice established guidelines and policies and procedures.
  • If determination is not made, forward PA request to Pharmacist.
  • Contact providers to obtain additional information needed to make determination.
  • Fax decisions to requesting providers.
  • Notify members of decision based on protocol.
  • Accurately enter appropriate authorizations and notify providers of approval.
  • Document criteria met in prior authorization system.
  • Complete processing within established timeframes; process incoming faxes.

Support the Pharmacy Quality Manager by making outbound phone-based interventions with members, providers and pharmacies to support quality of care initiatives. Perform assigned pharmacy projects.

  • Projects are assigned based by Supervisor, Lead or Managers
  • Projects will be worked on a daily, weekly or monthly basis
  • Projects status will need to be documented daily, weekly or monthly.
  • Provide one on one or group training as assigned by Supervisor
  • Projects will be worked in a timely manner and be completed without delay
  • Immediately communicate with Supervisor and/or Pharmacy Lead regarding any issues that will prevent or delay project from being completed.
  • Training of pharmacy staff and/or other departments.

Answer and resolve pharmacy prior authorization and pharmacy help desk calls.

  • Log into phone queue to service providers.
  • Answer inbound calls regarding authorizations within established time frame.
  • Document contact information in electronic medical record system.
  • Maintain productivity and handle calls professionally.
  • Provide accurate prior authorization information to provider offices.
  • Answer pharmacy help desk related questions.
  • Educate providers regarding health plan benefits.
  • Calls are answered within an appropriate time frame.
  • Document all calls appropriately.

Assist other departments with pharmacy related needs. Performs other position appropriate duties as required in a competent, professional, and courteous manner.

  • Assist Utilization Review Nurses and other department staff with obtaining authorizations and coordinating care for discharge planning, forward appropriate referrals to case management.
  • Enter authorizations for nurses for discharge care.
  • Collaborate with Behavioral Health staff for pharmacy-related requests.
  • Assist Member Services with formulary questions and pharmacy requests.
  • Assist Disputes/Appeals department with pharmacy-related information during appeals process.

Education / Experience / Other Requirements

Education:

  • High School Diploma or GED equivalent
  • Completion of Pharmacy Technician program preferred

Certification and License:

  • Licensed Pharmacy Technician or Technician in Training, active and in good standing

Years of Experience:

  • At least two (2) years pharmacy technician experience preferred
  • Previous Medicaid/Medicare experience preferred
  • Pharmacy Prior authorization/utilization review experience preferred
  • Call center experience preferred

Specialized Knowledge:

  • Knowledge of medical terminology
  • Knowledge of call center or customer service environment
  • Knowledge of medications
  • Knowledge of Medicare and Medicaid regulations preferred

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!

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