Pharmacy Technician - Case Management

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We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview

This position requires a Certified Pharm tech- CPht, as well as 2y previous prior medication authorization expereince. This is a hybrid position, Monday through Friday 40 hours a week. 3 days onsite and 2 days from home.

Under the direction of Case Management leadership, the Pharmacy Care Coordinator collaborates closely with the case management staff to provide a coordinated experience for patients and families. The primary responsibilities are to proactively identify medications requiring prior authorizations and obtain same, facilitate patient access to medication, provide documentation of prior authorization efforts, and maintain appropriate licensure. The role will be responsible for medication authorizations to optimize patient access to their medication therapy. The Pharmacy Care Coordinator will also answer calls, handle verification and identification of covered and non-covered medications, explanations of benefits structures, as well as necessary follow-up with families, providers, and payors regarding referral issues, authorization questions, insurance eligibility issues, copay assistance programs, and medication delivery as applicable. The Pharmacy Care Coordinator will cross-cover other areas as needed.

What you will do

• 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 post-discharge medications
• 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 Care Coordinator 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 discharge coordination process by attending rounds and 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.
• Keeps abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge in the performance of job duties.
• Participates in departmental process improvement initiatives.
• Identifies problems in process/procedures or services and makes recommendations for improvements.
• Update patient record by verifying demographic, insurance information, and pharmacy benefit management vendor (PBM).
• Ensure documentation is completed in Epic 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.
• Educate and inform family of outstanding financial obligations if appropriate.
• Execute prior authorizations via Cover My Meds.
• Participates in relevant pharmacy projects as needed.
• Conducts discharge follow-up patient phone calls; able to elicit information during follow-up calls and understands when to have case manager intervene.
• Runs Case Management Pharmacy-related reports as needed.
• Monitors, identifies and communicates to manager trends in payor responses to authorization requests.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity. Other duties as assigned.

Education Qualifications

• High School Diploma / GED Required
• Bachelor's Degree Preferred

Experience Qualifications

• At least two (2) years medication prior authorization experience Required
• At least two (2) years Pharmacy Benefits Management (PBM), Managed Care, Hospital Pharmacy, Home Infusion Pharmacy, and/or Retail Pharmacy experience Preferred

Skills and Abilities

• Ability to work in stressful situations and handle multiple tasks at the same time.
• Strong interpersonal, communication and organizational skills
• Ability to work efficiently and professionally with a minimum of supervision.
• Ability to be pro-active with following up on projects and tasks.
• Ability to learn quickly new procedures.
• Strong computer skills; proficient with Microsoft Word, Excel, and PowerPoint.
• Ability to juggle multiple insurance issues.
• Strong customer service skills.
• Excellent phone etiquette.
• Ability to handle confidential information.
• Ability to display compassion and empathy.
• CHOP mandatory required training completed within first 14 days:
• Website Insurance Training (Navinet, WebMD, Passport, Availity, etc.)
• EPIC training & testing.
• Pharmacy Insurance background preferred.
• Background in medical terminology preferred

Licenses and Certifications

• Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board - upon hire - Required

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.

Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.

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