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Banner Health Pharmacy Patient Advocate - Health Plan in Tucson, Arizona

Primary City/State:

Tucson, Arizona

Department Name:

Pharm Benefits Mgmt-Misc

Work Shift:

Day

Job Category:

Pharmacy

A position in a Banner Health pharmacy is one you can look forward to. Join an engaging environment of full service, high technology and experience a wide variety of responsibilities. You’ll also see how important a pharmacy job is to our ability to make life easier for our patients. Come enjoy great challenges and build both your knowledge of the field and your analytical skills.

The University of Arizona Health Plans provides interesting job opportunities where you will learn something new each day. At UAHP, we work hard to improve the lives of our members. We believe in member-centric care and go above and beyond for our members.

UAHP is a team that works hard on providing the best care, while working cohesively to assure the needs of each member are being met. In addition, you have the opportunity to impact the care of one of the most needy, disadvantaged populations. You will have the opportunity to work with a strong leadership team that works hard to guide and help each one of their employees grow. The hours are M-F, 8a-5p, with some weekends(depending on the needs of the business) and some call.

Your pay and benefits (Total Rewards) are important components of your Journey at Banner Health. Banner Health offers a variety of benefit plans to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.

Banner Pharmacy Services division provides excellent patient care across our entire continuum through convenient access, improved medication outcomes and innovative pharmacy practices. Banner Pharmacy Services will be recognized nationally as a clinical leader and trusted partner in proactively providing innovative pharmacy services through excellence in integration, care coordination, medication management and service to make a difference in people's lives. Banner is expanding its focus from being a hospital company to a clinical quality company focused on population health management. Clinical Pharmacy Services are also included in this robust new service line and are responsible for the management of the Banner formulary, development of standardized system wide clinical pharmacy services, and management of adverse drug event preventions. Clinical Pharmacy Services provides collaborative drug therapy management and educational interventions in patient care to optimize medication therapy, improve outcomes, promote wellness, and disease prevention.

POSITION SUMMARY

This position supports the Pharmacy Department in processing pharmacy prior authorization (PA) requests in an accurate and timely manner. Clinical decision making is performed using approved guidelines. Supports the internal and external customers of the Health Plan including members, providers, contracted pharmacies, case managers, medical prior authorization staff, and the customer care staff by addressing issues pertaining to pharmacy and providing pharmacy data as requested. Performs ad hoc reporting on pharmacy claims data as requested. Responsible for performing activities and functions in accordance with policies and procedures under the immediate supervision of a pharmacy technician supervisor, a pharmacist, and/or medical director.

CORE FUNCTIONS

  1. Processes and finalizes PA requests based on approved guidelines under the supervision of a pharmacist and/or a medical director: entering of PAs into the system and prioritizing requests; checking formulary alternatives, reviewing tried and failed medications; utilizing drug references and verifying the drug being requested is indicated/approved for the condition; documenting all related information regarding the PA approval or non-approval; monitors pending pharmacy prior authorization requests for compliance with regulatory timelines and contacts providers for requested information to avoid out of compliance decisions; respects and maintains highly confidential information as required by HIPAA.

  2. Understands the formulary, member cost-sharing, and regulatory requirements, both AHCCCS and Medicare. Assures that pharmacy claims are adjudicating correctly. Maintains compliance with all regulatory requirements.

  3. Communicates clearly and accurately with other healthcare professionals including internal personnel as well as individuals external to the organization. Assists internal and external customers with any pharmacy issues, investigates potential causes, and works to resolve issues in an efficient, comprehensive manner. Interacts with the pharmacy benefits management company to resolve any processing errors or system issues.

  4. Provides reporting for internal and external customers including, but not limited to, member pharmacy claims history, CSPMP profiles, and pharmacy claims analysis.

  5. Participates in the daily review of the Medicare denied claims report. Analyzes the reason for the denied claim and works with the pharmacy to resolve any processing issues. Outreaches to prescriber for prior authorization if indicated.

  6. Participates in regulatory oversight including, but not limited to, audits, operational reviews, or ad hoc data requests.

  7. Meets established departmental performance metrics for quality and productivity.

  8. Works independently under regular supervision. Uses structured work procedures and independent judgment to solve problems and achieve high quality levels. Work output has a significant impact on business goal attainment. Customers include members, pharmacists, providers, non-physician providers, other health care team members, health plan representatives and medical office staff for the purpose of integrating services, improving patient care and ensuring effective communication systems.

MINIMUM QUALIFICATIONS

Requires pharmacy technician licensure in the state of practice (where applicable). Pharmacy technician certification required.

Must demonstrate 3 or more years of experience performing pharmacy technician duties in a pharmacy setting with managed care emphasis preferably within a healthcare organization or retail pharmacy. Must have good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts. Must have the ability to learn and master various software programs necessary for job functions

PREFERRED QUALIFICATIONS

Knowledge of medication management information system software and automated dispensing systems. Previous experience with Medicare, Medicaid or Long Term Care preferred

Additional related education and/or experience preferred.

Date Approved: 6/3/2018

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

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