Overview

Supports Pharmacy Services Specialists and Director of Pharmacy Services to perform Quality Improvement interventions, including maintenance of data integrity, member outreach and reporting to fulfill other regulatory requirements. Works under moderate supervision.

Compensation Range:$20.98 - $26.23 Hourly

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 days of paid time off and 9 company holidays  
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability   
• Employer-matched retirement saving funds  
• Personal and financial wellness programs   
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care    
• Generous tuition reimbursement for qualifying degrees  
• Opportunities for professional growth and career advancement   
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities    
• Interdisciplinary network of colleagues through the VNS Health Social Services Community of Professionals.

What Will You Do

• Receives, downloads, reformats and reviews data in daily claims files and reports. Conducts preliminary audit of data and screens for potential issues. Addresses non-clinical operational issues as a result of report review, and alerts pharmacist to clinical follow up when needed.
• Prepares electronic files and creates Coverage Determination and Redetermination packages for pharmacist’s and Medical Director’s review.
• Reviews on-going PBM reports under pharmacist’s supervision. Addresses non-clinical issues and alerts pharmacist to needed clinical follow up.
• Performs quality checks of Formulary files prior to DOH or CMS submission. Compares files to identify and resolve discrepancies and/or missing information.
• Assists pharmacist with maintaining and tracking spreadsheets including obtaining, input and retrieval of prescription and related information.
• Conducts member outreach. Contacts members using standard script to assist with processing prescriptions, resolving copayment or ID card questions. Provides customer service and follow up on issues. Assists with retail pharmacy outreach. Contacts pharmacies to gather information and to resolve pharmacy benefit coverage and prescription eligibility and claim problems.
• Participates in on-going auditing/monitoring activities.

Qualifications

Licenses and Certifications:
NYS Pharmacy Technician Certificate required

Education:
High School Diploma or the equivalent required

Work Experience:
At least one year of pharmacy experience required Managed Care Experience preferred Bi-lingual (Spanish) preferred Proficiency in Microsoft Office (Word, Excel, PowerPoint) required