Feb 10, 2019
The position provides Pharmacy Benefits Manager (PBM) performance monitoring, resolve pharmacy and medication related issues for SHP members, review the practices and procedures of the PBM, and provide pharmacy, benefit and compliance related expertise to Sutter.
The PharmTech/Analyst position is needed to work on a number of critical initiatives including: PBM audit vendor selection and audit, PBM on site evaluation, clinical programs, like narcotic drug use review and adherence, specialty product channeling, compliance with DMHC regulations, PBM cost analysis with possible rate negotiations and special studies as determined by SHP.
The PharmTech will provide the following functions:
• PBM evaluation, implementation, and oversight
• Support PBM analytics, annual cost analysis, possible rate negotiations, clinical medication programs and audit
• Clinical monitoring, oversight and identify areas for new or increased performance standards and satisfaction guarantees
• Monitor, analyze and if possible manage high cost pharmacy claims
• Provides timely, accurate responses and resolutions to member complaints, and support for appeals and grievances.
Position holds authority to approve pharmaceutical care and to overturn pharmaceutical determinations following established guidelines and applying considerable clinical judgment, independent analysis, and detailed knowledge of pharmacy benefit management, managed health care, departmental procedures and clinical guidelines. This position is responsible to prepare cases for Pharmacy Benefits Coordinator, CMO and/or third party for review and determination.
This position will prepare summary reports, research and technology assessments for QI Committee and Pharmacy & Therapeutics Committee.
The Pharmacy Tech/Analyst is responsible for the coordination of services and cost effective management of pharmaceutical resources to meet individual members’ health care needs and promote positive health care outcomes. The responsibilities include assessment, coordination, planning, monitoring and evaluation of multiple environments. This position will acts as a member advocate and liaison between providers, members, pharmacies, PBM and Sutter Health Plus to seamlessly integrate services.
A Bachelor Degree or combination of education and experience is required.
**Experience / Knowledge / Skills:**
Must have demonstrated previous experience similar to the required duties. Must have at least 3-5 years working as a Pharmacy Technician AND 3-5 years in a pharmacy benefits management. Must be a Certified Pharmacy Technician (CPhT). Must have knowledge of data fields required by National Council for Prescription Drug Programs (NCPDP). Must be competent at running adhoc reports from pharmacy claims data with strong PC skills including PowerPoint, Access, Outlook, Excel and Word.
Experience in positions with exposure to PHI is essential. Must demonstrate knowledge of HIPAA, Health Care Reform, Business Code of Ethics and government regulated programs. Must demonstrate ability to work collaboratively, prioritize functions, problem solve, and anticipate upcoming issues for the executives.
**Organization:** Sutter Health System Office
**Employee Status:** Regular
**Position Status:** Non-Exempt
**Job Shift:** Day
**Shift Hours:** 8 Hour Shift
**Days of the Week Scheduled:** Monday-Friday
**Weekend Requirements:** Other
**Schedule:** Full Time
**Hrs Per 2wk Pay Period:** 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.