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Pharmacy Specialist

Amida Care New York, NY
  • Posted: over a month ago
  • Full-Time
  • Benefits: vision, dental, life_insurance, medical
Job Description

 This position is responsible for the support of the Amida Care Pharmacists in monitoring drug utilization trends to deliver positive results for our members in a particular area(s) of focus.  Serves an important link between Amida Care members, providers; pharmacies and Pharmacy Benefit Manager (PBM) for pharmacy benefit related issues and initiatives.  Participates in coordinating programs for our members that promote health and encourage appropriate medication use in a customer friendly environment.

ESSENTIAL FUNCTIONS
Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

•    Coordinate and assist providing pharmacy technical and analytical support to other Amida Care departments in support of providing all members and providers with accurate, timely and customer friendly information
•    Provide accurate and timely pharmacy reports from the Pharmacy information systems (e.g. PBM data tool) and perform initial analysis of pharmacy reports for interested parties
•    Serve as liaison between PBM and Amida Care Member Services to improve pharmacy services Amida Care offers; i.e., member eligibility, Restricted Recipient Program, utilization management inquires, pharmacy inquiries, etc.
•    Coordinate and deliver Amida Care Pharmacy Utilization Programs (Medication Authorizations, Appeals and Complaints), including but not limited to information gathering, data entry, request routine, obtaining laboratory data, request documentation, verbal and written communication of results, status updates, and develop and generate reports
•    Coordinate and perform customer service quality control and Service Level Agreement (SLA) compliance reviews of the PBM including quality control of PBM member calls and prior approval letters, as well as, reviewing PBM customer service statistics. Report aberrations and SLA failures to appropriate management staff
•    Perform quality control compliance review on pharmacy technician work to ensure state regulations are being met
•    Adept an identifying Pharmacy related Fraud, Waste and Abuse.  This includes application of pharmacy policies and procedures on a case-by-case basis to assist with adherence to the Prescription Monitoring Program (PMP) and the Restricted Recipient Program (RRP). Responsible for setting up and facilitating oversight meetings with PBM
•    Communicate with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives with appropriate and thorough follow up
•    Support organization quality initiatives (QARR, HEDIS, STARS) through initiative coordinating member/provider/pharmacy outreach as required to continuously improve the pharmaceutical and medical care provided to Amida Care Members.

MINIMUM JOB REQUIREMENTS

•    High School diploma or General Educational Development (GED).  Bachelor’s degree preferred
•    Two (2) years’ experience working with target population, specifically HIV/Specialty Pharmacy
•    Certification as a Pharmacy Technician (CPhT)
•    Five (5) years’ Retail Pharmacy experience or equivalent experience in healthcare
•    Three (3) years’ Manage Care experience
•    Strong knowledge and demonstrate applied use of Microsoft Office (Word and Excel)
•    Strong interpersonal and people skills
•    Strong time management, program oversight and organizational skills
•    Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts
•    Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

Company Description
Amida Care is a private, not-for-profit health care organization in New York City. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and the general well-being of our members. Amida Care is recognized in the health care industry as a high quality health plan that knows how to help our members get the care they need, in the amount they need at the time it is needed.

Amida Care's mission-driven approach is based on working closely with members and surrounding them with a community of committed providers who direct their care; social workers, health navigators, behavioral health specialists and a designated medical home. We specialize in providing comprehensive medical, behavioral and psychosocial support services to people with multiple chronic conditions.

Amida Care was founded in 2003 by community-based organizations in New York City:

Harlem United
Housing Works
Project Samaritan AIDS Services
Promesa
St. Mary's
Village Care of New York

Our most important goal is to help each member live healthier in all ways. We achieve this by encouraging the member and their doctors to work together to make the best decisions about care related to check-ups, specialist visits, pharmaceuticals, hospitalization, home care, behavioral health, vision care and more. Amida Care providers handle all of the special, complex needs of their patients including psychosocial and life challenges that arise.

Amida Care

Why Work Here?

Great Benefits! We offer Medical, Dental, Vision, Life Insurance, 403b Pension Plan and more.

Amida Care is a private, not-for-profit health care organization in New York City. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and the general well-being of our members. Amida Care is recognized in the health care industry as a high quality health plan that knows how to help our members get the care they need, in the amount they need at the time it is needed. Amida Care's mission-driven approach is based on working closely with members and surrounding them with a community of committed providers who direct their care; social workers, health navigators, behavioral health specialists and a designated medical home. We specialize in providing comprehensive medical, behavioral and psychosocial support services to people with multiple chronic conditions. Amida Care was founded in 2003 by community-based organizations in New York City: Harlem United Housing Works Project Samaritan AIDS Services Promesa St. Mary's Village Care of New York Our most important goal is to help each member live healthier in all ways. We achieve this by encouraging the member and their doctors to work together to make the best decisions about care related to check-ups, specialist visits, pharmaceuticals, hospitalization, home care, behavioral health, vision care and more. Amida Care providers handle all of the special, complex needs of their patients including psychosocial and life challenges that arise.

Address

14 Penn Plaza
New York, NY
USA

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