Drug Utilization Review Coordinator II

Pharmacy Benefit Management (PBM) Irvine, California Fresno, California


Description

PinnacleRx Solutions (PRxS) is a relationship-focused, pharmacy benefit manager that is designed to provide our customers and members, with solutions to meet their unique pharmacy needs. PRxS takes pride in giving its clients a five-star experience, in addition to retail and custom pharmacy networks, comprehensive data reporting, scalable products and services, consultative account management staff, customer support available 24/7 and customized benefit materials.

Job Description Summary

Position reports to the Supervisor, PBM, which is responsible for Supervising PBM Services for Pinnacle Rx Solutions. This position will be responsible for providing support to the DUR program via the DUR/Clinical Pharmacist III reviewer role.

Qualifications

  • Associates degree and five (5) plus years in direct patient care pharmacy practice environment preferred.
  • Pharmacy Technician Certification Board National Certification required.
  • Significant knowledge of prescription benefits, products and pharmacy claims.
  • Customer Service oriented with ability to set priorities and meet required turn-a-round times.
  • Intermediate knowledge of Microsoft Office Suite including word-processing and spreadsheet end-user software.
  • Excellent written and oral communication skills, as well as interpersonal skills.
  • Skilled at creating training documents in a project-based environment.
  • Robust analytical and critical thinking skills.
  • Ability to assume additional duties when required.
  • Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. up to 10% of the time. 

Duties And Responsibilities

Drug Utilization Program Support

  • Assist in the development of policies and procedures to support Drug Utilizations Programs as identified by Clinical Pharmacists.
  • Collaborate with Clinical Pharmacists to identify emerging areas of escalation within the DUR platform.
  • Coordinate Prior Authorizations and all other components of DUR for non-standard drug coverage issues between the prescriber, health plan, Medical Review department, Drug Utilization vendor and the third-party prescription vendor.
  • Collaborate with pharmacy analysts to gather DUR metrics and statistics as necessary to provide program metrics and report summarization.
  • Report and present DUR statistics, information, and outcomes with PBM leadership.
  • Coordinate with Health Management teams as required to provide cross-functional input to DUR and HM initiatives.
  • Collaborate to identify areas to improve member compliance and adherence.

Prescriber Relations

  • Liaise with prescribers and Clinical Pharmacist to ensure that relevant clinical information is gathered in a timely manner.
  • Ensure that DUR goals are available to prescribers as needed to promote outcomes.
  • Provide information and education to prescribers as topics emerge that may impact DUR programs or prescribing aspects.
  • Develop professional relationships with prescribers/prescriber staff to further promote our DUR programs and enhance the value of our company.

Operations

  • Maintain reporting metrics for DUR program and liaise with internal teams as needed for client reporting and savings determinations.
  • Be punctual and organized with e-mail, call tracking episodes, and other lines of communications.
  • Cross train with Pharmacy Benefit Coordinator I & II for coverage assistance.
  • Develop creative ways to understand how our customer’s and prescribers perceive their interactions with and the process for getting their medications here at PRxS.
  • Work with peers and leadership to improve customer service levels.
  • Provide suggestions and contribute to ongoing process improvements.

Other

  • Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
  • Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 10% of the time.
  • All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk and sit. The employee is frequently required to use hands to finger, handle, or feel objects, tools, or controls and reach with hands and arms. The noise level in the work environment is usually moderate.