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Wellcare

Pharmacy Technician

Wellcare - Tampa, FL

Pharmacy Technician','1803218','Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. WellCare is a Fortune 500 company that employs nearly 9,000 associates across the country and was ranked a ''World's Most Admired Company'' in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!Department: Pharmacy Operations

Reports to:   Supervisor, Pharmacy

Location:      George Rd., Tampa, FL 33634

Performs case processing, clinical evaluation and completion of coverage determinations from receipt to adjudication. Utilizes clinical knowledge and resources to evaluate and assess the clinical necessity of the coverage determination. Technician assignments will be broad in nature across DER, Injectables, Appeals and/or Direct Member Reimbursement (DMR). Essential Functions:

Reviews medical records against prior authorization criteria and decision tools and recommends a coverage determination decision on approvals and/or denials on various drug products.

Verifies eligibility, timeliness and record completeness of coverage determination cases and follows up with the provider as necessary

Communicates with Pharmacists and Medical Directors, providing updates on the case disposition of coverage determinations.

Researches and documents the clinical aspects of the case and the reasoning for the coverage determination outcome in numerous databases.

When appropriate, seeks additional clinical advice and recommendations to properly adjudicate the coverage determination case.

Electronically enters claim detail information in internal organization applications, PBM applications and documents receipt, disposition and other noteworthy aspects of the cases in these applications.

Initiates and continues direct communication with health care providers (Pharmacist, Physicians, and Nurses) involved with the care of the member to obtain complete and accurate information for coverage determination.

Ensures timely processing and review of coverage determinations to meet departmental goals and state/federal specific benchmarks for timeliness.

Documents data input and output accurately to ensure compliance with data integrity for CMS Universes and corporate compliance directives.

Ensures that services provided to eligible members are within benefit plan and appropriate medications are being utilized. (i.e.: determining if medication Part D eligible and the 4 brand limit.)

Assists with implementation of healthcare initiatives and specific strategies that improve the quality and outcomes of care in market.

Responds to requests from member service and other issues.

Performs additional projects as assigned. Additional Responsibilities:

','!*!Candidate Education:

Required A High School or GED Candidate Experience:

Required 1 year of experience in pharmacy operations managed care, hospitals and/or retail environments

Preferred 1 year of experience in managed care pharmacy and/or appeals/grievances Candidate Skills:

Intermediate Demonstrated interpersonal/verbal communication skills

Intermediate Demonstrated written communication skills

Intermediate Ability to effectively present information and respond to questions from families, members, and providers

Intermediate Ability to work independently

Beginner Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions

Intermediate Other Ability to use pharmaceutical references

Beginner Other Ability to evaluate information from both oral and written sources, pharmaceutical references and report information to pharmacists

Intermediate Other Working knowledge of prescription medications and pharmacotherapy Licenses and Certifications:A license in one of the following is required:

Preferred Certified Pharmacy Technician (CPhT) Technical Skills:

Required Intermediate Microsoft Word Knowledge of Microsoft Office including Word, Excel and Power Point

Required Intermediate Microsoft Excel Capable of learning to use Sidewinder, Crystal and WHI Data bases

Required Intermediate Microsoft Outlook

Required Beginner Healthcare Management Systems (Generic) Languages:

','US-FL-Tampa','4110 George Road','Independent Park','Tampa','33634','','','No','No','Pharmacy Technician

19 days 5 hours ago

Wellcare

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Pharmacy Technician Wellcare - Tampa, FL, United States

   

Location: Tampa, FL

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.