16 days old

Pharmacy Coordinator

Umpqua Health
Myrtle Point, OR 97458
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  • Job Code
    148349552
  • Jobs Rated
    41st
Full Time - Regular
Remote, Roseburg, OR, US




POSITION PURPOSE

Accountable for supporting medical management functions (utilization management, pharmacy management, and care coordination) with expertise in appropriate areas. Follow Umpqua Health Alliances policies and procedures, practice guidelines, state and federal guidelines and regulations, and other medical management resources. Serve as liaison to Oregon Health Plan members, ATRIO Health Plan members, providers, pharmacies, and community healthcare personnel. Works under greater supervision with guidance from more experienced staff, and focuses on performing standard medical management clinical review tasks.



ESSENTIAL JOB RESPONSIBILITIES
  • Maintain updated knowledge of the Oregon Administrative Rules (Medicaid) and Medicare rules (Part D and Part B) governing coverage determinations.
  • Assist in providing coordinated physical, mental, addiction, and dental care services.
  • Perform initial review of requests for coverage of pharmacy and medical services. Make decisions in a logical, consistent manner. Provide clear and accurate documentation of the reasoning process for decisions within allotted timeframes.
  • Prepare materials for claim review, medical review, pharmacy review, and care coordination including documentation of key findings, benefit determination, verification of codes and pricing, supporting standards citations, care plans, risk appraisals, and alternative and transitional care options.
  • Evaluate the cost and effectiveness of proposed/delivered services before, during, and after claims payment. Analyze claims data with consideration to medical necessity, the quality of care, and the appropriateness of the delivery of care, and covered benefits.
  • Perform pricing, coding and or medical necessity reviews prospectively, concurrently, and retrospectively ensuring compliance with internal and external standards set by regulatory and accrediting entities. Researches and adjudicates pharmacy and medical claims and contested cases to assure accurate application of contract benefits.
  • Educate members and practitioners about the health plan benefit structure and relevant rights and responsibilities.
  • As needed, work with the OHP and ATRIO Grievance and Appeals coordinator when they receive calls from a member or the members representative regarding concerns about the care being provided.
  • Assisting pharmacies as needed to ensure timely dispensing of medications. Performs data entry of pharmacy claims.
  • Communicates with providers on formulary or lower cost alternatives, prior authorizations and step therapy guidelines as well as state and federal criteria for services and supplies.
  • Assists Medical and Pharmacy Directors with maintenance of medical and prescription drug policies.
  • Above all, developing good working relationships with providers, pharmacies and staff.
  • Assist the Pharmacy Director with coordinating staff schedules and duties.
  • Comply with organizations internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
  • Other duties as assigned.





GUIDING BEHAVIORS

Accountability

Always demonstrate the highest performance and behavior standards. Share responsibility and expect others to be accountable.

Efficiency

Demonstrate a proactive approach to problem identification and solutions. Be innovative and solutions oriented improving processes while reducing costs. Demonstrate appropriate time-management skills. Optimize the use of available resources.

Be a Team Player

Support and assist your team members. Be available to help, and learn from your team. Keep an open mind to feedback and earn trust of staff.

Integrity

Keep your promises, commitments, and confidences. Be honest and straightforward dealing with all issues fairly and consistently.

Stewardship

Adhere to all state and federal regulations relating to your position including the Health Insurance Portability and Accountability Act (HIPAA), Fraud & Abuse and Occupational Safety and Health Administration (OSHA) laws. Abide by Company policies and procedures at all times.



CHALLENGES
  • Working with a variety of personalities, maintaining a consistent and fair communication style.
  • Satisfying the needs of a fast paced and challenging company.





QUALIFICATIONS
  • Current Pharmacy Technician licensure, National and with State of Oregon.
  • 1-2 years of clinical experience in a health-related setting.
  • Customer service skills preferred.
  • Fluent in pharmaceutical and medical terminology and acronyms.
  • Self- discipline to follow policies, procedures, and workflows.
  • Ability to collaborate with others and function as a part of a highly functioning team.
  • Organize and prioritize workload according to goals and specified turnaround times.
  • Effective written and oral communication skills.
  • Proficient computer skills MS Word, Excel, and Outlook, as well as proven experience researching on the Internet.



PHYSICAL DEMANDS

Typical office environment requiring standing, sitting, walking, bending, and lifting up to 25 pounds. May be exposed to patient and environment conditions such as unpleasant sights, smells and contagious diseases.






PI148349552

Jobs Rated Reports for Pharmacist

Posted: 2021-09-29 Expires: 2021-10-31

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Pharmacy Coordinator

Umpqua Health
Myrtle Point, OR 97458

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Pharmacist
41st2019 - Pharmacist
Overall Rating: 41/199
Median Salary: $126,120

Work Environment
Good
82/220
Stress
Very Low
44/220
Growth
Poor
169/220
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