GENERAL SUMMARY:

Responsible for handling of daily pharmacy duties such as drug claim adjudication issues, prior authorization, and pharmacy benefit inquiries from members/patients, physicians, pharmacies, and other internal and external individuals. Subject matter expert in the resolution of pharmacy benefit coverage issues and coordinating prior authorization and exception processes.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Act as a central resource to manage and monitor prior authorization and its validityprior to fill and provide a reason if prior authorization is denied.

• Relays all communications to patients and providers regarding authorization outcome.

• Proactively renews prior authorization in timely manner to provide continuity of care.

• Proactively research and secure financial assistance for all patients.

• Interpret patient treatment plans and medical notes for purposes of facilitating authorization requests.

• Evaluate & communicate with nursing and physician staff any additional requirements or potential barriers to the treatment plan.

• Act as a resource to assist with education of new hires.

• Create and maintain patient/member information in applicable systems.

• Work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.

• Perform additional related duties as assigned and necessary.

  EDUCATION/EXPERIENCE REQUIRED:

• High school diploma or G.E.D. equivalent. Associates degree preferred.

• A minimum of one year of previous pharmacy experience required.

• State of Michigan Pharmacy Technician Licensure preferred.

• Strong understanding and knowledge of medical/clinical and pharmacy terminology.

• Working knowledge of personal computers, and business software such as Microsoft Office.

• Organizational and time management skills, as evidenced by the capacity to prioritize multiple tasks and job duties/responsibilities.

• Strong interpersonal communication skills and experience with interacting with customers

Additional Information

• Organization: Community Care Services

• Department: Pharmacy-Utilization Mgmt

• Shift: Day Job

• Union Code: Not Applicable

  Additional Details

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.com.

Benefits

Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.