Pharmacy Care Navigator

Job Description:

About the Role

As a Pharmacy Care Navigator, you’ll collaborate with comprehensive interdisciplinary roles as part of a managed care team to minimize gaps in treatment and eliminate barriers to medication adherence. You will provide members with medication reconciliation, access, adherence and affordability services, identifying and communicating discrepancies to build long-term solutions. You’ll connect Cityblock members and care teams to pharmacy resources and support enrollment in qualifying copay assistance programs. This position acts as a medication therapy liaison and navigator for the member, the Cityblock care team, external providers, and the health plan. You will also serve a clinical pharmacist extender, performing administrative and clinical support tasks to enhance the delivery of comprehensive medication management services.

Responsibilities 

• Serve as the pharmacy team’s first line of triage and subject matter expert for medication access, adherence and affordability needs including prior authorizations (PA), PA appeals, copay assistance, rx billing issues with the pharmacy, med synchronization, blister packing and delivery. 

• Assist in upkeep of market specific medication formularies and network pharmacies

• Provide ongoing care team education on medication access, adherence and affordability tools and resources 

• Proactively screen disease state registries, medication adherence reports, and incoming referrals from our care teams to confirm member eligibility for the clinical pharmacy program. This includes review of member medication lists, hospital discharge paperwork, external/internal lab tests and other necessary clinical documents 

• Schedule members referred or identified as eligible for initial pharmacist consult visits; perform reminder phone calls and appointment rescheduling as necessary

• Assist with verifying medication list details (medication history taking), alerting the pharmacist of discrepancies as per clinical protocol 

• Facilitate sending of pharmacist correspondence and communications to external prescribers and outside pharmacies for loop closure  

• Participate in market specific quality initiatives (HEDIS/Stars) to support positive clinical outcomes and drive down utilization cost 

• Participate in medication safety projects, assist in identification of drug shortages and development of internal management plans/memos

Requirements for the Role 

Education & License requirements

• Associates Degree

• Certifications Required: Pharmacy Technician Certificate from PTCB; 

Experience

• ​You have a minimum 6 years experience as a pharmacy technician in a retail and/or outpatient pharmacy 

Computer Skills

• Experience with EHR, G Suite, email, slack, etc. 

Medical Terminology

• Prior experience with and knowledge of medical terminology, ICD-10/CPT codes, third party billing resolution,including Medicaid/Medicare/dual, prior knowledge of pharmacy insurance prior authorization process and experience with medications. 

​Leadership

• You are an independent self-starter and a strategic thinker who …