Pharmacy Technician

Job Overview:

The Stars Pharmacy Technician plays a vital role in ensuring timely medication adherence for members, directly impacting the organization's quality performance measures. This position is responsible for proactively managing members who fall into specific quality measure denominators to prevent gaps in care.

Essential Responsibilities:

The Pharmacy Technician will play a crucial role in supporting the Hamaspik Medicare Advantage and Medicaid Manage Care pharmacy programs. The primary focus of the position is to manage and execute our internal medication adherence outreach workflows and improve quality measures, particularly those related to the Centers for Medicare & Medicaid Services (CMS) Star Ratings program. The technician will work collaboratively with the pharmacy director, care managers, and network pharmacies to ensure members receive timely and appropriate medication therapy while reducing reliance on external vendor outreach.

A core function of this role is to facilitate communication among all stakeholders. The technician will:

Contact Members' Pharmacies: They will work directly with pharmacies to confirm prescription statuses, resolve issues, and ensure a smooth medication dispensing process.
Coordinate with Primary Care Physicians (PCPs): The technician will communicate with PCPs to address any prescription-related concerns, such as refill requests, to prevent delays in care.
Collaborate with Care Managers: They will partner with care managers to share updates on member adherence, identify barriers to timely medication fills, and coordinate support services as needed.
Process Prior Authorizations: Assist with coverage determinations and process prior authorizations as needed to maintain operational coverage.

Data Management and Reporting: Execute tracking and reporting tasks by utilizing Excel (including pivot tables) for pharmacy projects and monitor adherence KPIs.

Other Duties: Perform all responsibilities as assigned by your supervisor.

By performing these tasks, the Pharmacy Technician directly contributes to improving medication adherence rates and positively impacting quality performance measures.

Required Education, Experience, and Licenses:
• High school diploma or equivalent
• 1 – 2 years of experience as a pharmacy technician, preferably in a managed care setting
• High proficiency in Microsoft Excel, including the ability to utilize pivot tables and manage large data sets
• Pharmaceutical Knowledge
• Pharmacy Software Proficiency
• Medical Terminology
• Excellent communication skills
• Problem solving skills
• Detail oriented and accuracy with documentation

Preferred Qualifications:
• Active PTCB Certification
• Bilingual proficiency (Spanish or Chinese)
• Previous experience with Medicare Part D Star Ratings, medication adherence programs, or Medication Therapy Management (MTM)
• Familiarity with Rx Nova, Guiding Care, or similar claims processing and care management platforms

Managed long-term care plan providing healthcare services to Medicaid-eligible individuals.