Member Advocate - Pharmacy

Required:

1. High School diploma or equivalent.
2. National Pharmacy Technician Certification
3. One year experience in a retail, hospital, managed care, or other similar pharmacy setting.
4. Minimum typing speed of 35 words per minute
5. Demonstrate working knowledge of direct claims processing, pharmacy computer systems, spreadsheet applications (i.e., Microsoft Excel), phone system and other office/computer equipment as required.
6. Knowledge of pharmaceutical generic and trade names.
7. Ability to comprehend and follow established office routines, policies, and procedures.
8. Effective oral and written communication skills, including grammar and spelling.
9. Strong organizational skills, time management and multi-tasking abilities.
10. Detail oriented with advanced analytical and problem-solving skills.
11. Ability to work effectively as part of a team and independently.
12. Provide excellent customer service.
13. Follow all plan policies and procedures.

Desired:

1. Degree in health-related field.
2. Experience performing medication authorizations in pharmacy or managed care environment.

Responsibilities:

1. Complete timely and accurate documentation of contacts and outcomes in referral platform.
2. Performs research to identify appropriate community resources and maintains information of available resources to meet various member needs.
3. Directs members on how to apply for low-income subsidy for Medicare Part D.
4. Prioritizes assignments appropriately and maintains flexibility as new priorities arise.
5. Promotes communications, both internally and externally, to enhance effectiveness or pharmacy services for membership.
6. Strives to improve quality in all areas of responsibility and cooperate with all departments to improve quality throughout The Health Plan.
7. Ensures that all financial assistance applications are processed timely and accurately.
8. Provide excellent customer service to members and providers.
9. Consults with clinical pharmacists for guidance and assist if necessary.
10. Gathers clinical documentation necessary for the performance of medication reconciliation and yearly medication reviews and refers documentation to a Care Management Pharmacist for review if needed.
11. Work DSNP IR referrals for diabetic and nebulizer testing supplies.
12. Work any pharmacy mail marked “Return To Sender.”
13. Back-up for ACD lines and completes medication coverage requests during peak seasons and if short staffed.
14. Meets internal key performance indicators as defined in The Health Plan’s Policies and Procedures.
15. Member Advocates/Pharmacy Technicians are responsible for reporting any changes in licensure status (e.g., application declined/denied; license revoked/suspended or lapsed; notification of an investigation by licensing board; becoming subject to disciplinary action by a licensing board) to their direct supervisor throughout their term of employment.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.