Job Description

This position is responsible for coordination and performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of the Quality Medical Management Division. Position includes integrating technical pharmacy aspects with that of Medical Review, Case Management, Mental Health/Chemical Dependency, and Quality Management. Technician responsibilities include communicating directly with Providence Health Plan (PHP) Customer Service and PHP Members, PHP Network Pharmacies, and regulatory entities at the federal and state level. The position also communicates directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives.

Other duties may include:

• Coordinates and processes independently pharmacy prior authorizations taking into consideration pharmacy benefits, medication utilization policies, documented technician approval criteria, information submitted by prescriber, and age-related presentation of member requesting.

• Maintains pharmacy benefit member eligibility review process and database. Oversees point-of-service claims transactions processed on a daily basis through Argus Health System. Refers unusual occurrences to Argus Analyst/Coordinator.

• Takes, triages and documents incoming calls and requests, identifies and obtains resource for those requiring immediate attention, handles those appropriate through established protocols utilizing appropriate level of assessment and judgment. Routes work to other resources as deemed appropriate. Monitors, retrieves, and prioritizes incoming work as required.

• Performs intake and system data entry of information such as authorization and referral requests, patient information, discharge information, medication therapy management information, drug utilization management information. Uses sound judgment in identifying the need for clinical review or pharmacist/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures. Maintains the accuracy and integrity of the database

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com .

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Skills and Requirements

• 3+ years' experience as a pharmacy technician in a managed care environment, OR 3 years pharmacy technician experience in an outpatient pharmacy

• Certified Pharmacy Technician in the state of Oregon null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to HR@insightglobal.com.