Pharmacy Technician - Health Plan - Remote - Medicare Advantage Institutional Special Needs Plan (I-SNP) Operations

Join Our Team: Pharmacy Technician - Health Plan - Remote

American Health Plans, a division of American Health Partners Inc., is seeking a highly skilled and compassionate Pharmacy Technician to join our team on a remote basis. As a key member of our Pharmacy Benefit Management team, you will play a critical role in ensuring the smooth operation of our Medicare Advantage Institutional Special Needs Plan (I-SNP). If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity.

About American Health Plans

American Health Plans is a leading provider of Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. Our mission is to improve the quality of life for our members by providing high-quality, patient-centered care that reduces emergency room visits and avoidable hospitalizations. We operate in several states across the country, including Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana, with plans for expansion into other states in 2025.

Benefits and Perks

We offer a comprehensive benefits package that includes:

• Affordable Medical/Dental/Vision insurance options: We provide a range of insurance options to ensure you and your family are well-protected.
• Generous paid time-off program and paid holidays for full-time staff: You deserve time to relax and recharge. Our paid time-off program and paid holidays will help you achieve a healthy work-life balance.
• TeleDoc 24/7/365 access to doctors: With TeleDoc, you can access medical care from the comfort of your own home, 24/7.
• Optional short- and long-term disability plans: We offer optional disability plans to provide financial protection in case of unexpected events.
• Employee Assistance Plan (EAP): Our EAP provides confidential support and resources to help you manage personal and professional challenges.
• 401K retirement accounts with company match: We help you plan for your future with a 401K retirement account and company match.
• Employee Referral Bonus Program: Refer a friend to join our team and earn a bonus!

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). As a Pharmacy Technician, you will play a critical role in ensuring that our members receive the right medications and treatments.

Key Responsibilities:

• Review daily point-of-service (POS) pharmacy claims: You will review POS pharmacy claims to ensure accuracy and completeness.
• Resolve actionable items and track reporting: You will resolve any issues that arise during the claims review process and provide reporting as needed.
• Serve as a liaison with Enrollment Department: You will work closely with the Enrollment Department to ensure that member eligibility is processed correctly.
• Effectively work with the PBM management team: You will collaborate with the PBM management team to ensure that our pharmacy benefits are managed effectively.
• Recognize formulary requirements: You will need to understand and recognize formulary requirements, including prior authorization, step therapy, and quantity limits.
• Communicate with pharmacies, nursing homes, and providers: You will communicate with pharmacies, nursing homes, and providers to resolve issues and ensure that our members receive the right care.
• Coordinate clinical reporting: You will coordinate clinical reporting to ensure that our members receive the right treatments.
• Follow-up and solve open items in a timely manner: You will follow up on open items and resolve them in a timely manner.
• May be assigned to work on special projects and business initiatives: You may be assigned to work on special projects and business initiatives to help drive our mission forward.

Requirements and Qualifications

Essential Qualifications:

• High school diploma or equivalent: You must have a high school diploma or equivalent.
• Minimum of 2 years as a Pharmacy technician, long-term care, or health plan experience: You must have at least 2 years of experience as a pharmacy technician, in long-term care, or in a health plan.
• Proficient with Microsoft Suite applications: You must be proficient in Microsoft Suite applications, including Word, Excel, and Outlook.
• Ability to navigate multiple systems: You must be able to navigate multiple systems and software applications.
• Strong analytical skills: You must have strong analytical skills to review and analyze data.
• Proficient communication and presentation skills: You must have excellent communication and presentation skills.

Preferred Qualifications:

• Pharmacy Technician certification: A pharmacy technician certification is preferred.

What We Offer

We offer a competitive salary and a comprehensive benefits package, including opportunities for career growth and professional development. As a remote employee, you will have the flexibility to work from home and enjoy a better work-life balance.

Why Join Our Team?

At American Health Plans, we are committed to improving the quality of life for our members. We are a collaborative, supportive, and caring team, and we are looking for individuals who share our passion for healthcare. As a Pharmacy Technician, you will play a critical role in ensuring that our members receive the right medications and treatments. We offer a dynamic and supportive work environment, opportunities for career growth and professional development, and a comprehensive benefits package.

How to Apply

If you are a motivated and detail-oriented individual with a passion for healthcare, we encourage you to apply for this exciting opportunity. Please click the "Apply Now" button to submit your application. We look forward to hearing from you!

American Health Plans 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.