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Pharmacy Benefit Technical Specialist
Albany, NY
Job Description
Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Pharmacy Benefit Technical Specialist is responsible for implementing and monitoring the technical aspects of pharmacy benefits. This individual implements medical exception/prior authorization decisions made by Pharmacists and/or Managed Care Pharmacy Technicians. Specialists will be responsible for answering calls from a pharmacy phone queue, advising on pharmacy matters from internal and external sources, as well as additional ad hoc project work which supports the pharmacy department. Specialists will participate in an on-call/holiday rotation along with a utilization management pharmacist and managed care pharmacy technicians to support Plan members in after hour pharmacy issues.
QUALIFICATIONS:
The Pharmacy Benefit Technical Specialist is responsible for implementing and monitoring the technical aspects of pharmacy benefits. This individual implements medical exception/prior authorization decisions made by Pharmacists and/or Managed Care Pharmacy Technicians. Specialists will be responsible for answering calls from a pharmacy phone queue, advising on pharmacy matters from internal and external sources, as well as additional ad hoc project work which supports the pharmacy department. Specialists will participate in an on-call/holiday rotation along with a utilization management pharmacist and managed care pharmacy technicians to support Plan members in after hour pharmacy issues.
QUALIFICATIONS:
- Associates degree required. 2 years relevant experience may be substituted for degree.
- Minimum three (3) years of experience in health care/managed care related field required.
- Minimum one (1) year in pharmacy service is preferred.
- Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required.
- Demonstrated ability to work with system support customers as well as interfacing with IT personnel to solve problems as required.
- Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions.
- Must be detail-oriented with strong organizational skills, including the ability to coordinate workflow.
- Excellent verbal and written communication skills
- Flexibility to adapt to a changing and fast-paced environment.
- Demonstrated ability to work with and maintain confidential information.
- Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
- Ability to cover rotating on-call responsibilities, as well as a late shift on Fridays.
- Ability to work additional hours as needed in order to meet turnaround time responsibilities.
Hourly range: $20.00-$25.00
CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.
CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.
CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Salary and Benefits
20 To 25 (USD) Hourly
Required Education
Associate Degree
Required Experience
2+ years
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