Pharmacy Case Manager

Description

Family First Health is seeking a Pharmacy Case Manager for our George Street, York location. Candidates should have a working knowledge of medical terminology and be computer proficient or have the ability to learn. As a Pharmacy Case Manager at Family First Health, you should have a positive and outgoing personality with excellent customer service skills and strong organizational skills.

This position is more than just a job, it’s an opportunity to learn and grow with a terrific team. We’re dedicated to offering trustworthy medical services and care. The Pharmacy Case Manager position will play a large role in that. If this sounds a like a good fit, we would love to hear from you.

Essential Duties And Responsibilities

Under the direction of the Pharmacist in Charge, the Pharmacy Case Manager collaborates closely with the pharmacy and primary care staff to provide a coordinated experience for patients and families.

• Provides information of Pharmacy benefit structures to patients/caregivers, clinical team and physicians as well as perform the following responsibilities:
• Eligibility verification;
• Prior Authorizations for medications;
• Identifying and communicating to patients expected out-of-pocket costs and copay assistance programs;
• Prompt documentation in the medical record of status of the prior authorization and any interventions;
• Assist with appeals of any denied prior authorizations;
• Introduces and explains scope of Pharmacy Case Manager services to the patient/caregiver to include the following: medication history, refill coordination, access to emergent services, and clinical care team or pharmacist escalation as appropriate;
• Provides support to the primary care teams by collaborating with the clinical pharmacist;
• Provides customer service when answering incoming patient calls, communicating with patients on urgent requests, and communicating with medical/nursing staff to obtain key information needed;
• Assists with coordinating and scheduling the prescription delivery process;
• Follows up with insurance companies and families of patients identified as ineligible or non-covered;
• Contacts family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party. Contact clinical care team with all information that requires follow-up;
• Participates in departmental process improvement initiatives.
• Updates patient record by verifying demographic, insurance information, and pharmacy benefit management vendor (PBM);
• Ensure documentation is completed in Athena and PioneerRx, that includes but not limited to the status of the prior authorization including medication name, quantity, dose, length of authorization, and any denial/appeal information if applicable;
• Verify coverage through third party benefit coverage/authorization vendors;
• Able to elicit information during follow-up calls and understands when to have case manager intervene;
• Monitors, identifies and communicates to manager trends in payer responses to authorization requests;
• Supports the pharmacy team as a pharmacy tech when there are absences in coverage for pharmacy operations, as directed by the PIC or Director of Pharmacy Operations.
• Assists patients with completing sliding scale applications and ensures all required supporting documentation is properly submitted.
• Assists with vaccinations including patient scheduling and vaccine administration as needed.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity. Other duties as assigned.
  
  

Knowledge/Skills/Abilities

• High School Diploma or GED required; Bachelor’s Degree preferred
• Active Pennsylvania LPN license preferred
• Unrestricted driver's license and the ability to assist with pharmacy delivery services periodically, as deemed necessary by department leadership
• At least two (2) years’ experience in medication prior authorization
• At least two (2) years’ experience in Pharmacy Benefits Management (PBM), Managed Care, Hospital Pharmacy, Home Infusion Pharmacy, and/or Retail Pharmacy preferred
• Ability and willingness to obtain PTCB National Certification
• Familiarity with medical terminology and/or pharmacy insurance preferred
• Ability to quickly grasp and adapt to new procedures, technologies, and company policies
• Knowledge of basic arithmetic to make calculations, balance and reconcile figures necessary to perform essential job functions
• Excellent organizational, customer service & phone etiquette skills
• Ability to take initiative and proactively follow up on projects/tasks.
• Ability to critically think which means the ability to think clearly and rationally about what to do or what to believe; understand logical connections between ideas; and identify, construct, and evaluate arguments
• Ability to work independently with minimal supervision, as well as within a multidisciplinary team
• Ability to work in, and respond appropriately to a demanding environment and multitask effectively
• Ability to appropriately handle sensitive and confidential information
• Ability to communicate well and in a caring and supportive manner with individuals of all backgrounds.
• Ability to work efficiently and accurately with strong attention to detail
• Ability to establish and maintain effective working relationships with patients, employees, volunteers, and the public
• Ability to be organized, proactive in follow-up and follow-through, and to juggle multiple competing tasks
• Ability to adhere to all Family First Health’s policies, processes, and procedures, including Code of Conduct.
• Ability to articulate and advocate Family First Health’s mission and values
  
  

PHYSICAL DEMANDS

Mental/Physical Requirements: Must p ossess the physical and mental abilities to perform the tasks normally associated with a Pharmacy Case Manager position such as:

• Requires correct vision and hearing to normal range.
• Frequent and prolonged work at a computer and/or on the phone for extended periods of time with repetitive typing, arm and hand motion
• Constant exposure to individuals who may have disease, infection, and/or virus
• Occasional bending, stooping, crouching, or kneeling
• Frequent standing and walking
• Frequent turning and reaching
  
  

Employee Benefits

• 3 Weeks of Accrued Paid Vacation accrued per year
• 9 Days Accrued Paid Sick Leave Time accrued per year
• 4 Personal Days provided per calendar year
• No Late Evenings or Weekend Hours
• Paid Time Off on Holidays
• Health, Dental, & Vision Insurance Plans
• Short/Long Term Disability and Life Insurance
• 403(b) Retirement Plan
• Tuition Reimbursement Opportunities
• Attention to work-life balance
• Opportunity for growth and advancement
• And More!