Shift End Time: 6 PM AWS Hours Requirement: 8/80 - 8 Hour Shift Additional Shift Information: 8 hour shift between 8:00am through 6:00pm Weekend
As Needed On-Call Required: No Hourly
(Minimum - Midpoint - Maximum): $31.350 - $39.180 - $43.890 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.
The purpose of this job is to expand Sharp Specialty Pharmacy Services by offering services to all qualifying patients and to increase patient satisfaction. This position will be clinic facing in SRS and SCMG and will work with provider and staff to locate and recruit patients that are prescribed specialty medications. Also, this position will provide efficiencies in procuring specialty drugs and assisting providers with any issues (prior authorizations) that may result in the course of treatment with these specialty medications.
Required Qualifications H. S. Diploma or Equivalent 1 Year Specialty pharmacy experience.
California Pharmacy Technician License (TCH) - CA State Board of Pharmacy -REQUIRED Driver's License - CA Department of Motor Vehicles -REQUIRED
2 Years Pharmacy experience in a related clinical area. Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board -PREFERRED Other Qualification Requirements Utilizes reliable transportation and possesses adequate personal insurance coverage. Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.
Clinical and Education Services As a member of the clinic team, work seamlessly along side clinicians to serve patients both face-to-face in a medical clinic office and over the phone. Educate prospective pharmacy patients on how Sharp Specialty Pharmacy serves patients and improves their overall care. Support outpatient retail and specialty prescription medication needs.
Grow the specialty pharmacy’s patient population. Ensure that patients remain on track with medication regimens - outbound therapy/medication adherence check-ups; secures refill prescriptions. Communicate effectively with the Pharmacy Team with respect to: the refill report, the zero-fill report, the monthly outstanding report and the appointment list.
Help develop new processes to ensure smooth operations and patient care. Collaboration and Teamwork Clearly communicates goals and instruction to other staff members, including handoffs between shifts. Participates in staff orientation and student/resident training programs.
When faced with complex situations, has knowledge of and applies appropriate policies and procedure; effectively evaluates ongoing workflow issues and directs daily workload to achieve efficiency and maximize resource utilization as business needs require. Attends and participates in staff meetings and communications. Reads email at a minimum of daily.
Fosters positive relationships and teamwork through consistent respectful, professional interactions Customer Service Provides prompt, accurate and excellent services to internal and external customers. Develops a trusting collaborative relationship with medical offices, internal SHARP and external to SHARP, vendors, providers, and all patients. Answers phone and emails in a timely and friendly manner.
Department Efficiency and Effectiveness Organizes and completes daily requirements and responsibilities. Telephone Message Management - Ensures prompt and efficient return of messages according to established policy. Troubleshoots and resolves problem calls.
Daily Organization - Monitors patient flow, pharmacists’ schedules and completes daily tasks to ensure quality and meet service standards. Completes work within assigned hours. Able to respond to changing circumstances and prioritize patient needs.
Responds to urgent and emergent situations in a calm and capable manner. Utilizes good judgment and problem-solving ability. Ensures readiness of reports and information to maximize patient visit.
Protect organization's value by keeping information confidential. Assists in other departments as assigned to meet staffing needs and travels to other sites as business needs arise. Data Collection Communicates with appropriate medical offices to obtain laboratory data or pertinent chart notes for all prior authorization requests.
Processes information received, verifying eligibility and benefits coverage and applying plan specific criteria to information received. For requests not received, provides rationale for non-approval. Rationale supporting documentation are provided to clinical reviewer for final determination.
Database entry and maintenance with100% accuracy. Collects data for management and pharmacist QA reviewer. Medication Adjudication Works collaboratively with the pharmacy benefits manager (PBM’s) to ensure appropriate adjudication of medications that are authorized by health plans.
Monitors the PBM adjudication system and identifies discrepancies. Communicates prior authorization decision to medical offices/pharmacies, within established timelines. Prior Authorization Requests Receives and processes prior authorization requests for medications from members, staff, physicians, and pharmacies within the required turnaround time set by health plans.
Reviews patient insurances to assess most cost-effective covered therapies and any applicable prescribing restrictions. Assesses financial risk distributions based on health insurance requirements and provides appropriate information on alternate therapies, as needed. Receives prior authorization requests and evaluates requests using established guidelines.
Where guidelines do not exist, performs independent research using available resources to assess approval/ non-approval of prior authorizations requests. Performs reviews and makes approval determinations for those requests that meet medical necessity criteria, appropriate utilization management and health plan criteria. For requests that do not meet criteria or coverage or are benefit exclusions, prepares complete documentation supporting rationale for non-approval.
Provides all documentation and rationale to clinical reviewer for final determination. Documentation includes rationale for denial, potential appropriate alternatives, proposed member physician denial letter language. Pharmacy technicians are not authorized to make denial determinations.
Sends out appropriate determination notifications within required timeframe. Other Duties Participates in special projects and other duties assigned. These may include, but are not limited to: Work groups, proposals, audits, and back-up support for other departments.
Performs department audits, assists with national and state audits, and solves customer care issues. Take initiative to reach out to appropriate vendor contacts for problem resolution. Maintains and adjusts drug supply inventory (patient supplies and packaging materials).
Always organizes and keeps medication refrigerators and work areas clean per policy. Schedules annual appointment in a timely manner. Reviews weekly reports and takes appropriate action as needed.
Performs quality checks of formulary programming and assists with the implementation of Pharmacy and Therapeutics initiatives and policies. Committee changes such as new or revised guidelines, drafting Benefit coding requests, and communication of changes to PBM vendor. Performs training for new employees.
Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class