Pharmacy Technician

Other Miramar, Florida


Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina. In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Group1001 is on a mission to empower consumers. Our family of companies share a common goal: giving people more control over their money, making it easier for them to do businesses with us, and creating more opportunities for them to see value every day. 

Job Summary:
  • Ensures department productivity and quality, including measures like Star Ratings (e.g., Adherence improvement, Medication Therapy Management, Statin usage in patients with diabetes,) and reports on patient safety.
  • Provides timely MTM services under the direct supervision of pharmacist.
  • Speaks to HealthCare members daily regarding adherence and other pharmacy initiatives.
  • Participates in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving managed care pharmacy practices.
  • Enters on-line approvals or denials of requests per departmental approved guidelines/standards.
  • Provides support in obtaining clinical information for programs as needed to support health plan initiatives.
  • Solves Rx claim issues with pharmacy providers/provider representatives.
  • Follows department P&P and SOPs to meet company goals and ensure compliance.
  • Attends regular staff meetings.
  • Assists with mentoring of new team members.
  • Completes assigned work plan objectives and projects on a timely basis.
  • Maintains professional relationships with provider community and internal and external customers.
  • Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
  • Complies with required workplace safety standards.
  • Expertise in Medical /pharmacy terminology, drug nomenclature, basic pharmacology.
  • Experience with speaking to members about medication adherence, working with providers and pharmacies to assist in procurement of medications for members, quality initiatives, and pharmacy laws and regulations.
  • Prior Managed Care/MTM Experience preferred.
  • Understanding of managed care pharmacy principles and insurance coverage issues.
  • Demonstrated ability to communicate, problem solve, and work effectively with people.
  • Excellent organizational skill with the ability to manage multiple priorities.
  • Work independently and handle multiple projects simultaneously.
  • Knowledge of applicable state, and federal regulations.
  • Ability to take initiative and see tasks to completion.
  • Computer Proficient (Microsoft Office Products).
  • Excellent verbal and written communication skills.
  • Ability to abide by policies.
  • Ability to maintain attendance to support required quality and quantity of work.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.
  • Working with Pharmacy Team to ensure successful Adherence Outreach Program for members.
  • Working on Clinical programs that include documenting cases on Case Management System of members that are in Drug Management Program, Medication Adherence Program, Statin Use in Persons with Diabetes and additional clinical programs as assigned.
  • Contacting members to explain the MTM program and scheduling calls for pharmacist to complete patient interview.
  • Reviewing and executing on P&P as it relates to Daily Claims rejection files to ensure that members can receive their medications timely.
  • Assisting in Medicare part D grievances resolution as needed.
  • High School Diploma or GED equivalent Completion of the Certified Pharmacy Technician Training Program
  • Minimum of 2 years of experience as a Pharmacy Technician in the ambulatory, community, home infusion, long term care or managed care setting required.
  • 2 years of healthcare industry experience preferably managed care experience.
  • Required Licensure/Certification: Active license in good standing as a pharmacy technician with State Board of Pharmacy