Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Pharmacy Technician will be responsible for supporting the clinical, operational, and quality functions of Bright HealthCare’s pharmacy department. This role will be responsible for implementing clinical outreach to members to ensure safe medication use, improve medication adherence, and lower the total cost of care for our members. The Pharmacy Technician will also be responsible for providing oversight of clinical programs of our Pharmacy Benefits Manager(PBM), providing support for the Pharmacy & Therapeutics Committee (P&T), and providing support to the individual market teams to increase drug affordability, improving quality measures and positively impact the member experience.
The Pharmacy Technician job description is intended to point out major responsibilities within the role, but it is not limited to these items.
- Make calls to members that may have discontinued sensitive medications to ensure that there are no gaps in care or hospitalizations. This helps reduce hospitalizations and improve our CAHPS scores in the Medicare population.
- Make calls to members, providers, and pharmacies that are currently non-adherent or are approaching medication non-adherence. This will encompass identifying the issue(s), triaging issues, and conveying a plan to the member, provider, and pharmacy. May need to do refill reminder calls to certain members monthly if necessary.
- Make calls to members who are eligible for Medication Therapy Management (MTM) to schedule a Comprehensive Medication Review (CMR) to discuss their medications, lower-cost alternatives, side effects, etc. This helps to ensure optimum therapeutic outcomes and improve Medicare STAR ratings.
- Provide outreach in the first quarter of the year to members experiencing a transition fill in the Medicare line of business. This will help ensure there are no lapses in medication use and improve Medicare CAHPS scores.
- Track and trend call volumes and outcomes of interventions provided.
- Review Complaints to Medicare (CTM) that are drug-related and provide outreach if necessary.
- Review processed claims for accuracy to improve member experience, provide oversight of PBM, and ensure appropriate access to drugs.
- Provide support to Clinical Pharmacists to ensure timeliness and accuracy of clinical projects, including formulary submission, P&T meetings, and cost-saving initiatives.
- Review transition fill letters for accuracy and timeliness to ensure all requirements are met per CMS guidelines.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree required
- Five (5) years of experience in the pharmacy industry required
- Successful completion of a Certified Pharmacy Technician Course and certification exam (state or national) is required
- Knowledge and experience of Medicare Part D, Individual & Family Plans (IFP), Commercial and Medicaid pharmacy business is preferred
- Proficient in MS Office Suite (PowerPoint, Word, Excel) is preferred
- Bilingual in English and Cantonese, Mandarin, Korean, Vietnamese, or Spanish is highly preferred
- Strong writing and verbal communication skills.
- Proficient in simplifying complex clinical information into tactical solutions that reduce pharmacy costs and promote quality measures.
- Previous call center experience
- Comfortable following timeline-driven work plans and managing multiple projects.
- Strong operational mindset and ability to use data to draw insights.
- Must thrive in collaborative environments.
- Comfortable using an interpreter service.
LICENSURES AND CERTIFICATIONS
- Active and unrestricted Pharmacy Technician license nationally or in any US state is required.
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Some travel may be required.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
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