Do you wish to join a team of pharmacy professionals? We at Providence Health Plan (PHP) Pharmacy are looking for you to join our team. We support our pharmacy plans and the member care by providing our expertise in the application of pharmacy benefits management. This means that we have a phone center and prior authorization center focus. Excellent communications skills and attention to detail are required for this role. Daily work involves an inbound call center setting that communicates directly with various departments within the health plans, members, network pharmacies, and other health care providers and their staffs regarding medication management programs and initiatives. The position also communicates directly with state and federal regulatory entities. We are excited to receive your application join our team of highly skilled professionals at Pharmacy Member Services.
Providence is calling a Quality Technician who will:
Be responsible for coordination and performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of the Quality Medical Management Division
Be responsible for communicating directly with Providence Health Plan (PHP) Customer Service and PHP Members, PHP Network Pharmacies, and regulatory entities at the federal and state level
Communicate directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives
Takes, triages and documents incoming calls and requests, identifies and obtains resource for those requiring immediate attention, handles those appropriate through established protocols utilizing appropriate level of assessment and judgment
Routes work to other resources as deemed appropriate. Monitors, retrieves, and prioritizes incoming work as required
Performs intake and system data entry of information such as authorization and referral requests, patient information, discharge information, medication therapy management information, drug utilization management information
Uses sound judgment in identifying the need for clinical review or pharmacist/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures
Maintains the accuracy and integrity of the database
Acts as department liaison and resource to members, Health Plan providers, and Health Plan departments to problem solve or address inquiries regarding work, workflow, processes, information system issues and relationships
Communicates with members, patients, network pharmacies and providers to obtain information, signatures and appropriate sign off in order to facilitate workflows
Develops written communications to prescribers and network pharmacies as directed
Serves as knowledge holder on pharmacy matters within the health plan and serves as a consultant as needed and within scope of position
Continuously monitors security and safety of medical records and medical information to protect confidentiality
Recommends and initiates change to ensure continuous quality improvement in work processes
Researches pended claims and authorizations or incomplete medical records and provides resolution or recommendations for solution
Identifies, notifies, documents and distributes information related pharmacy department work, and patient follow-ups, alerting the appropriate people as necessary
Collects, organizes, reviews and verifies records submitted by prescribers and network pharmacies knowing that records are subject to both federal and state review and/or audit
Maintains sound working knowledge of all relevant policies and procedures. Develops written procedures for workflow processes
Required qualifications for this position include:
- 2 years' experience as a pharmacy technician in a managed care environment -OR- 3 years' experience as a pharmacy technician in an outpatient pharmacy
Preferred qualifications for this position include:
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.
Requsition ID: 107489
Company: Providence Jobs
Job Category: Clinical Quality
Job Function: Quality/Process Improvements
Schedule: Full time
Career Track: Admin Support
Department: 5018 PHARMACY OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.