Shift End Time: 6 PM AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information: 8 hour shift between 8am through 6pm. Saturday coverage as needed Weekend
As Needed On-Call Required: No Hourly
(Minimum - Midpoint - Maximum): $28.170 - $35.210 - $39.430 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.
To assist in the day-to-day operations of the pharmacist and pharmacy department and maintain quality of service to our physicians and patients. Supports front end and clinical procedures within the pharmacy department including initial intakes, follow-ups, and discharges as necessary. Assist the pharmacist in providing pharmaceutical services that support the mission, values and philosophy of Pharmacy Services and Sharp Healthcare.
Performs technical tasks involved in the preparation, documentation and distribution of patient medications. Required Qualifications Experience with documenting in an electronic medical record (EMR) and competency in Microsoft Office. California Pharmacy Technician License (TCH) - CA State Board of Pharmacy -REQUIRED
1 Year General pharmacy practice experience. Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board -PREFERRED Other Qualification Requirements Certified Pharmacy Technician (CPhT) or equivalent is preferred.
Collaboration and teamwork Operational Services (dealing with internal customers): Clearly communicates goals and instructions to other staff members, including handoffs between shifts (written/oral); Participates in staff orientation and resident/student training programs. Effectively intercepts and troubleshoots problems, as demonstrated by effective problem solving, prioritization of issues with respect to level of significance and impact to patient care, safety, workflow, and communication.
When faced with complex situations, has knowledge of and applies the appropriate policies and procedures; Effectively evaluates ongoing workflow issues as and directs daily workload to achieve efficiency and maximize resource utilization as business needs require; Attends and participates in staff meetings or reviews staff meeting communications; Reads work related email at a minimum on assigned workdays. Customer Service/Interdepartmental Relations (Dealing with external Customers): Answers phone in timely, friendly manner, stating department, name, and title; Fosters positive relationships through consistent, respectful, professional interactions with customers; Responds to requests in a timely, caring manner that is consistent with Sharp behavior standards, (i.e. attitude).
Customer service Provides prompt, accurate and excellent services to internal and external customers. Develops solid professional working relationships with various internal departments and units and, as required, vendors, providers, employers, brokers and/or other customers. Data collection and documentation 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. Makes determination to approve requests, as appropriate. For those requests not approved, provides rationale for non-approval.
Rationale and all supporting documentation are provided to clinical reviewer for final determination. For approvals and denials, documents determinations and rationale. Responsible for maintaining databases that are 100% accurate.
Collects data for SSPS QA pharmacist. Medication adjudication Works collaboratively with the Sharp Health Plan pharmacy benefits manager (PBM) to ensure appropriate adjudication of medications that are authorized by Sharp Health Plan. Monitors the PBM adjudication system and identifies discrepancies.
Communicates prior authorization decision to medical offices and/or pharmacies, within SHP turnaround timelines. Other duties Participates in special projects and other duties as 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. Takes initiative to reach out to appropriate vendor contacts for problem resolution. Maintains and adjust drug and supplies inventory (patient supplies and packaging materials) Always organizes and keeps medication refrigerators & work areas clean per policy.
Schedules patient 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.
Committee changes such as new or revised guidelines, drafting Benefit Coding Requests, and communication of changes to PBM vendor. Performs training for new employees. Prior authorization requests Receives and processes prior authorization requests for medications from members, staff, physicians, and pharmacies within the required turnaround times set by Sharp Health Plan.
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 authorization requests. Performs reviews and makes approval determinations for those requests that meet medical necessity criteria, appropriate utilization management and Sharp Health Plan criteria.
For requests that do not meet criteria for 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 and physician denial letter language.
Pharmacy technicians are not authorized to make denial determinations. Sends out appropriate determination notifications within required time frame. Knowledge, Skills, and Abilities Capable of providing support to pharmacist at multiple sites within Sharp Specialty Pharmacy.
Ability to organize and prioritize projects. Excellent verbal and written communication skills with basic knowledge of medical terminology. 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