Pharmacy Access & Solutions Tech

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Job Summary: The PBM Operations Technician will work with a team of pharmacists, technicians, and analysts to provide daily support regarding such items as formulary maintenance, prior authorization processing, and benefits documentation/communication. 

Description of Job Responsibilities: 

• Develop and maintain drug lists and clinical edits associated with the formularies and utilization management strategies. 
• Support the prior authorization program in all aspects including review of individual requests, communication of new and changing criteria, providing appropriate formulary alternatives, and working with physicians, patients and the claims adjudicator. 
• Coordinate the process of entering formulary information from various sources such as the Pharmacy and Therapeutics Committee for adjudication and communicating changes to the appropriate outlets. 
• Maintain up-to-date member and physician facing formulary documentation and make it available through the appropriate channels. 
• Participate in and operationalize solutions to address inappropriate utilization, improve outcomes and optimize drug spend. 
• Respond to and resolve pharmacy-related inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and Prior Authorization determinations for covered health plans. Appropriately triage inquiries to a pharmacist when clinical expertise is required. 
• Effectively and accurately communicate with patients in a way that is compassionate and exemplifies the principles of Carolina Care. 
• Provide project support and complete other projects/initiatives as assigned. 

Other Information

Other information:
Education Requirements:
● HS diploma or equivalent.
Licensure/Certification Requirements:
● Registration with the NC Board of Pharmacy unless enrolled in a PharmD program.
● CPhT from PTCB or ExCPT from NHA unless enrolled in a PharmD program.
Professional Experience Requirements:
● Two years of pharmacy technician experience required.
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HCS Managed Pharmacy Solutions

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.