Job Description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. For more information, visit

AmHealthPlans.com

.



If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

Affordable Medical/Dental/Vision insurance options Generous paid time-off program and paid holidays for full time staff TeleDoc 24/7/365 access to doctors Optional short- and long-term disability plans Employee Assistance Plan (EAP) 401K retirement accounts with company match Employee Referral Bonus Program

JOB SUMMARY:

The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan's Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).

ESSENTIAL JOB DUTIES:

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.


Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting

Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing

Effectively work with the PBM management team to effectively ascertain the highest level of Pharmacy Benefit Manager performance

Recognize formulary requirements: prior authorization (PA, Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes

Communicate with pharmacies, nursing homes, and providers

Coordinate clinical reporting

Follow-up and solve open items in a timely manner

May be assigned to work on special projects and business initiatives

Other duties as assigned

JOB REQUIREMENTS:

Proficient with Microsoft Suite applications

Ability to navigate multiple systems

Strong analytical skills

Proficient communication and presentation skills

Adhere to Centers of Medicare and Medicaid Services (CMS) regulations and compliance requirements

Successful completion of required training

REQUIRED QUALIFICATIONS:

Education:


o High school diploma or equivalent


Experience:


o Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience



o Experience in planning and implementation


License/Certification(s):


o Pharmacy Technician certification preferred

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.



This employer participates in E-Verify.


Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.