Clinical Technician: Pharmacy Benefits Manager (PBM)

The Clinical Technician is responsible for assisting the clinical pharmacist with clinical programs within MaxCare. This includes, but is not limited to, timely operation of the daily prior authorization workflow, completion of drug formulary updates, maintenance of MaxCare clinical program utilization to assure maximum efficiency and effectiveness, and production of clinical materials for distribution to internal and external recipients. The clinical technician is also responsible for assisting the clinical pharmacist in responding to client clinical inquiries and creating clinical recommendations for specific client needs.

ESSENTIAL JOB FUNCTIONS:

· Assist clinical pharmacist in managing the daily workflow of prior authorizations to ensure prior authorizations are reviewed according to national, state, and internal MaxCare standards.

• Assist clinical pharmacist in developing and maintaining updates on drug utilization management programs/policies (e.g. create and maintain guidelines and criteria governing appeals, quantity limits, step therapies, age/gender limits, prior authorizations and other clinical programs).

· Assist clinical pharmacist by working in cooperation with the account management and sales team to provide clinical program consultation that will yield effective recommendations to clients for benefit implementation.

• Assist clinical pharmacist by working collaboratively with clients and account managers to assist in the design of custom benefit management programs including cost savings analysis, claims data analysis, and clinical recommendations.
• Assist clinical pharmacist by producing MaxAlert pharmacy alerts for internal and external distribution.
• Employ continuous quality improvement (CQI) to improve the efficiency and effectiveness of the drug utilization management strategy process.
• Create individual strategic goals annually to align with MaxCare’s strategic goals, mission, and vision.
• Perform other duties and activities as determined by the Clinical Services Director, as it pertains to the business needs, vision, and goals of MaxCare.

ADDITIONAL RESPONSIBILITIES:

• Assist in the training and mentoring of pharmacy students, interns, and/or residents.
• Perform other duties and activities as determined by the Senior Vice President or Clinical Services Director.

MINIMUM QUALIFICATIONS FOR CONSIDERATION:

• Education
  • High school or equivalent.
  • Undergraduate or higher education preferred.
• Experience
  • Demonstrates strong clinical background in PBM, managed care, and/or clinical practice settings.
  • Two years of experience in managed care and/or clinical practice settings.
• Specialized Accreditation
  • Active pharmacy technician licensure in good standing with the Oklahoma State Board of Pharmacy with no restrictions recommended.
  • National pharmacy technician certification (PTCB) recommended.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Familiarity with prescription benefits claims processing and formulary design.
• Robust knowledge of MediSpan data system, including the GPI drug classification system.
• Compelling customer service orientation and commitment to professionalism.
• Proficiency in PC applications, including Microsoft Office.
• Sophisticated verbal and written communication skills.
• Highly developed organizational and time management skills.
• Outstanding interpersonal, problem-solving, and analytical skills.
• Adeptly works collaboratively in a team environment.
• Demonstrate resourcefulness and ability to take initiative in development and completion of projects within designated timelines.

PHYSICAL REQUIREMENTS

This work is sedentary and requires the following physical activities:

• Sitting for long periods of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking, hearing, and visual acuity.
• Frequent lifting (up to 10 pounds of paper supplies or minor office equipment).
• Driving to client locations, office, and other sites as needed.

WORKING CONDITIONS:

• Office environment.
• Remote work environment: This position is eligible for remote work based on remote work qualifications and maintaining high quality productivity.

COMPANY DESCRIPTION:

• MaxCare Prescription Benefit Services is redefining pharmacy benefit management. We provide clients with the knowledge, clarity of options, and flexibility they need to effectively manage pharmacy benefits. We focus on developing programs, services, and processes that are clinically based, member-focused, and aligned for all stakeholders. MaxCare delivers an innovative mix of market expertise, information technology, and specialty pharmacy offerings. We serve the needs of health plans, unions, third-party administrators (TPAs) and self-insured employers.

NOTE: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.