• Job Description

  Req#: 25-67265
  
  Job Profile Summary
  
  Position Purpose:
  Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
  
  Education/Experience:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
  
  For Superior Health Plan:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
  License/Certificate: Current state’s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.
  
  For Arizona Complete Health:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
  License/Certificate: Current Arizona Pharmacy Technician license.
  
  For Pharmacy Services:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
  License/Certificate: Current state's Pharmacy Technician license preferred.
  
  Responsibilities
  Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
  
  Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
  
  Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
  
  Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
  
  Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
  
  Assist with the pharmacy utilization review and reporting process
  
  Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
  
  Assist with members’ inquiries related to the formulary process
  Performs other duties as assigned
  
  Complies with all policies and standards
  
  EEO:
  
  “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
  
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  Job Profile Summary
  
  Position Purpose:
  Perform duties to support the efforts pharmacy department in the development, coordination and maintenance of the health plan's pharmacy program.
  
  Education/Experience:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
  
  For Superior Health Plan:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
  License/Certificate: Current state’s Pharmacy Technician license and Pharmacy Technician Certification Board (PTCB) or the ability to obtain both license and PTCB within 30 days of the start date.
  
  For Arizona Complete Health:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred.
  License/Certificate: Current Arizona Pharmacy Technician license.
  
  For Pharmacy Services:
  High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment. Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users.
  License/Certificate: Current state's Pharmacy Technician license preferred.
  
  Responsibilities
  Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
  
  Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
  
  Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
  
  Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
  
  Assist Provider Relations and various departments with educating providers on the health plan’s pharmacy process
  
  Assist with the pharmacy utilization review and reporting process
  
  Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
  
  Assist with members’ inquiries related to the formulary process
  Performs other duties as assigned
  
  Complies with all policies and standards
  Story Behind the Need
  What is the purpose of this team?
  Describe the surrounding team (team culture, work environment, etc.) & key projects.
  Do you have any additional upcoming hiring needs or is this request part of a larger hiring initiative?
  The team’s purpose is responsible for building and maintaining decision tools, also known as questionnaires. These tools support pharmacy operations, specifically around prior authorization processes. We develop and manage configurable questionnaires that align with health plan and drug policies which help the prior authorization reviewers make their determination.
  
  We are a collaborative and supportive team that values clear communication, accountability, and continuous improvement. This team works cross-functionally with other pharmacy operational teams. We’re part of a large pharmacy department that is focused on optimizing workflows and improving patient outcomes through smarter, more efficient tools.
  
  Typical Day in the Role
  Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
  What are the performance expectations/metrics?
  What makes this role unique?
  Create DT loaders in Excel that will be uploaded to MHK/Compass platform.
  Configure decision tools into the MHK/Compass platform.
  Conduct testing to ensure decision tools are proper functioning.
  Update decision tools to align with integration of Client.
  
  Follow training instructions and complete training sessions in a timely manner.
  Expectation will be to maintain high-quality level work.
  Pay close attention to details.
  Complete monthly configuration on time.
  Candidate Requirements
  Education/Certification Required: high school diploma Preferred:
  Licensure Required: NA Preferred: prefer a Pharmacy Technician License but not required.
  Years of experience required: 3+ years of Pharmacy Technician experience (open to PBM, retail, or other various experience)
  
  Disqualifiers:
  
  Additional qualities to look for: Ability to multitask or properly prioritize work, Experience with projects or assignments that require attention to details.
  Top 3 must-have hard skills stack-ranked by importance
  1 Pharmacy Technician experience (open to PBM, retail, or other various experience)
  2 Microsoft Office Experience – Excel, Word, Outlook, Visio
  3 Ability to work independent and keep good communication with about their project/assignment updates.
  Candidate Review & Selection
  Shortlisting process
  Candidate review & selection
  Interview information
  Onboard process and expectations
  Projected Manager Candidate Review Date: 1-2 days post shortlisting
  
  Type of Interviews: Teams-camera on
  Required Testing or Assessment (by Vendor): NA
  Next Steps
  Additional background check requirements (List DFPS or other specialty checks here)
  
  Do you have any upcoming PTO?
  
  Colleagues to cc/delegate
  
  Are there any training requirements (time off, alternate schedule, etc.)?
  
  

• About the company

  Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.

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