Pharmacy Services Technician

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Reporting to the Senior Manager of Pharmacy Operations, the Pharmacy Services Technician is primarily responsible for supporting day-to-day operations of the pharmacy's utilization management program, processing any inquires, or escalations received by the Pharmacy Benefits Manager (PBM), the Plan's Customer Care or Provider Services departments, and/or Care Management teams. Other functions may include, but are not limited to, supporting prior authorization reviews, formulary management changes, website updates for pharmacy related benefit changes, and participation in special programs.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate.

* Supports responsibilities of pharmacy services operations for WellSense's Medicaid and Exchange lines of business, related to, but not limited to, formulary, compliance, reporting and oversight functions as directed by and in collaboration with the Pharmacy Operations Team.

* Function as a pharmacy liaison with other departments, including but not limited to such as Appeals and Grievances, Care Management, and Member/Provider Services. Educates other departments regarding Pharmacy processes as necessary.

* Coordinating resolution of escalated member, pharmacy and provider inquires related to the prescription drug benefit by working directly with the PBM and other pharmacy vendors

* Refers emails, calls and faxes to services, formulary and operations teams as appropriate; escalating to Managers, Medical Director or Pharmacy Directors as needed

* Coordinates daily activities such as review and resolution of claims reject reports and transition monitoring

* Meets defined response time outlined in department policies, procedures and workflows.

* Provides support of multiple pharmacy programs, including but not limited to

o Medication Therapy Management

o Prescription Drug Monitoring

o Retrospective Drug Utilization Reviews

* Supports clinical pharmacy staff as needed and facilitates communication between the internal team and the providers. Drafts and sends provider communications as needed to ensure member access to medications

* Act as primary point of contact within Pharmacy Services for internal and external pharmacy-related inquiries, escalation and some communications.

* Develops and maintains expert knowledge on all regulations from CMS, state agencies, division of insurance, etc. as they relate to pharmacy services operations

* Supports the pharmacy department with any Ad-Hoc projects requiring coordination support

* Supports the pharmacy operations team with prior authorization processing as needed.

* Other duties as assigned by department Supervisors

* Regular and reliable attendance is an essential function of the position

Supervision Received:

* Direct supervision received weekly.

Qualifications:

Education Required:

* Minimum of a High School diploma or equivalent required. Associate or Bachelor's degree preferred

Experience Required:

* Three or more years of experience in a professional setting required

* Three or more years prior pharmacy experience required

* Prior customer service experience required

* Prior managed care experience in a Medicaid and /or Medicare Plan preferred

Required Licensure, Certification or Conditions of Employment:

* Certified pharmacy technician

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Excellent Customer Service skills

* Prior experience assisting members and/or providers with telephone inquiries

* Strong organizational, problem solving, communication, and interpersonal skills

* Excellent written and oral communication skills required.

* Must have strong data entry and attention to detail in building cases

* Must be able to multitask and be results oriented

Working Conditions and Physical Effort:

* Regular and reliable attendance is an essential function of the position.

* Ability to work in a fast-paced environment.

* Work is normally performed in a typical interior/office work environment.

* No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees