DescriptionBe a part of our Pharmacy Clinical Programs Overutilization Review and Monitoring team. Provide guidance to members who have potential medication over utilization or medication interaction concerns. Your role will be to work within the process parameters to help make connections with health care providers that will guide our members' treatment and ensure medication safetyResponsibilitiesThe Rx Clinical Programs ORM Pharmacy Technician Representative assists in reviewing members pharmacy history for overutilization. Job is to manage the case when it is determined that the member would benefit from a program that would help them manage how they obtain their medications.Share the results of review and provide analytical support for case reviews by case management.
Take action on any recommendation from case management.
Generate and analyze reports related to prescription fills, maintain caseload, prepare cases for case management recommendation, and take case action as directed.
Run reports to support the internal requests for data and analysis as related to medication overutilization as required.
Interface with internal and external resources to ensure successful change in members' medication overutilization or drug seeking behavior.
Outbound calls to prescribers and pharmacies to validate demographics.
Inbound calls from prescribers, pharmacies and members to educate and assist with overutilization programs.
Coordinate and address any letter communication as directed by case management.
Prepare presentations and communication materials on behalf of the Clinical Programs Overutilization Review and Monitoring.
Coordinate and plan meetings as required.
Required QualificationsAZ, TX, FL, or Ohio Pharmacy Technician license
National Pharmacy Technician - PTCB or ExCPT
High School diploma or equivalent
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint, workflow management systems
Strong verbal and written communication skills, including the ability to tailor communication to audience
Ability to handle multiple tasks, meet deadlines, and follow-up timely
Previous experience working with data analysis & problem solving skills
Preferred QualificationsPrevious experience with pharmacy claims
Bachelor's Degree in Business or a related field or equivalent experience/education
Additional InformationThe Rx Clinical Programs ORM Pharmacy Technician Representative scheduled hours are Monday through Friday, 8:00-5:30 EST phone coverage. Candidates can reside in AZ, TX, FL or OH but need to be available to work 8:00-5:30 EST time zone .Vaccine PolicyHumana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.Please note: Some areas of our business, such as the Primary Care Organization including CenterWell, Conviva, Kindred at Home, onehome, SeniorBridge, Neighborhood Centers, Pharmacy Distribution Centers and others, may be required to adhere to federal, state or local or additional workplace guidelines.Work-At-Home Requirements:WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Why Humana?At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:Work-Life Balance
Generous PTO package
Health benefits effective day 1
Annual Incentive Plan
401K - Immediate company match
Paid Volunteer Time Off
Student Loan Refinancing
If you share our passion for helping people, we likely have the right place for you at Humana.Social Security Task:Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.Scheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.