Care Specialist III - Pharmacy Benefits
Job ID: 100534 Date posted: February 05, 2020
- Sharp HealthCare
- SCMG Utilization Management
- Clerical Jobs
- Day Job
As the Care Specialist III - Pharmacy Benefits, you will review more complex requests for injectable medications, home infusion medication, nursing and other services related to use of nebulizers, insulin pumps, Continuous Glucose Monitoring Systems, retrospective claims review of these services and facilitation and care coordination of all other pharmacy services in accordance with Sharp Community Medical Group (SCMG) referral guidelines. This position is responsible for pharmacy services delivered to all SCMG regions.
Sharp Community Medical Group is an association of private practice primary care physicians and specialists who practice in their own private offices located conveniently throughout San Diego County. The Sharp Community Medical Group network includes over 200 primary care physicians and over 700 specialists who currently provide care to more than 137,000 patients. You can expect to receive convenient, comprehensive and high-quality medical care offered by caring physicians who live in your community and are committed to excellence in your health care experience.
Sharp Community Medical Group doctors admit to all Sharp hospitals and Rady’s Children Hospital. In addition, Sharp Community Medical Group patients have access to urgent care centers throughout the county.
This position is located in Kearny Mesa, San Diego County.
Required Skills and Qualifications
- Current unencumbered CA Pharmacy Technician licensure
High School graduate or equivalent
Current CA certificate as a Pharmacy Technician or a current certificate of graduation from an accredited Medical Assistant Program.
Minimum of 3 years’ experience in a pharmacy setting or patient care setting with related job responsibilities is required.
Proficient use of ICD-9, CPT4, and HCPC coding systems.
Requires a thorough understanding of the functions of managed care, including HMO eligibility, claims, utilization management and the financial impact of decisions related to these processes.
Ability to research, investigate and resolve, prior authorization request and appeals from physicians providers health plans, and patients.
Ability to apply Health Plan, Milliman, National Comprehensive Cancer Network (NCCN) and other evidenced based criteria appropriately to referral requests under review.
Experience in HMO or delegated risk medical group/IPA setting is preferred.
Ability to work independently in research and decision-making with minimal direction from higher level staff.
Proficient in Microsoft Office and IDX.
Excellent organizational and time management skills, excellent analytical and problem solving skills.
Excellent verbal and written communication skills.
Ability to read, speak, and hear English clearly.
Preferred Skills and Qualifications
- Nationally Certified Pharmacy Technician (CPhT)
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.
Keywords: pharmacy technician jobs in San Diego, PBM, pharmacy benefits management
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