Position Purpose
The Pharmacy Member Advocate serves as a resource for members of Renown/Hometown Health to help obtain financial support/assistance in cases where such aid is needed, and provide administrative work in closing care gaps in pharmaceutical care such as medication non-adherence. This position is required to demonstrate competence, certification, and ability as a pharmacy liaison (pharmacy technician). This position is also responsible for developing relationships with medical practice groups and serve as their subject matter expert on pharmacy benefits.
The primary responsibility of incumbent is to assist the member in obtaining prescribed medication who are financially burdened. Therefore, incumbent is responsible for gathering, accessing, and compiling information about drug assistance programs and to work closely with the healthcare team to provide alternatives for members who could otherwise not afford it. This position will also interface with providers and pharmacies to support internal departments in improving performance in the organizations CMS Star Rating program. This position will resolve member-level barriers to medication non-adherence and provide member-level and provider-level solutions to close gaps in care.
Once members have been identified as qualified participants in a financial support/assistance program, it is expected that incumbent will proactively determine the members needs, and ensure that qualification in such programs continue as long as necessary when cost is the barrier to receiving pharmaceutical care.
Nature and Scope
This position is challenged to communicate effectively and diplomatically with the public, medical provider office staff, and pharmacy staff and other hospital staff. This position must function efficiently under stress; and be able to identify and maintain priorities, respond to simultaneous requests and maintain courteousness and be tactful.
This position has flexibility to work remotely with willingness to travel to provider offices and other areas within our service areas when needed. Demonstrates interpersonal skills to maintain effective communication with co-workers, other hospital employees, and patients. Knowledge of the pharmaceutical, managed care, and PBM industries is preferred. Must have strong process improvement skills necessary to get things done. Knowledge of State and Federal regulations as they pertain to the health insurance industry. Experience with CMS Star ratings and care gap reports,
Knowledge of Medicare Advantage and commercial plans. Experience reviewing and analyzing statistical data to identify trends as well as potential problems/opportunities for improved service quality. Familiarity with and ability to quickly learn multiple software tools. Ability to manage multiple priorities simultaneously and effectively.
Duties & Responsibilities:
Interface with external physician/provider practice groups, both onsite and telephonically, to coordinate optimal care related to drug therapies and eliminate care gaps such as medication non-adherence
Interface with members as needed to resolve cost and gap issues that each member may come across
Assist, problem-solve, and resolve any provider issues that the Medication Adherence Outreach Team and the Primary Care Physician identify
Coordinate prescriptions between members, providers, and pharmacies, as needed, to resolve prescription issues and to remove barriers to medication non-adherence
Regularly interface with internal stakeholders to communicate needs of the provider practice groups to encourage closure of gaps in care
Execute on other programs and tactics developed by the Pharmacy Director and other internal stakeholders to improve pharmacy-related Star Rating performance
Support the Quality Director and other internal stakeholders in decision-making and process development to improve pharmacy-related Star Rating performance
Perform other duties and responsibilities as assigned.
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name
Description
Education:
Associates degree with a focus in business administration or healthcare preferred.
Must have working-level knowledge of the English language, including reading, writing and speaking English.
Bilingual in English and Spanish preferred
Experience:
Requires at least one year of experience working in a medical office, hospital, or health insurance company with a focus on Medicare Advantage plans preferred.
Preferred 2 years of experience working in a retail pharmacy.
2 years of relevant experience may be substituted in lieu of Registered Pharmacy Technician license
Strong analytical skills using Excel
Excellent, effective written and verbal communication skills required.
License(s):
Pharmacy Technician (CPhT) license preferred.
Valid State of Nevada or California driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.
Certification(s):
Pharmacy Technician (CPhT) license preferred.
Computer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.