Job Information

Providence Quality Pharmacy Technician (Remote) in Oregon


Do you wish to join a team of pharmacy professionals? We at Providence Health Plan (PHP) Pharmacy are looking for you to join our team. We support our pharmacy plans and the member care by providing our expertise in the application of pharmacy benefits management. This means that we have a phone center and prior authorization center focus. Excellent communications skills and attention to detail are required for this role. Daily work involves an inbound call center setting that communicates directly with various departments within the health plans, members, network pharmacies, and other health care providers and their staffs regarding medication management programs and initiatives. The position also communicates directly with state and federal regulatory entities. We are excited to receive your application join our team of highly skilled professionals at Pharmacy Member Services.

Providence is calling a Quality Technician Pharmacy who will:

  • Be responsible for coordination and performance of technically detailed pharmacy and benefit work affecting pharmacy and health plan operations, programs and information systems in the Pharmacy Services Department of the Quality Medical Management Division

  • Be responsible for communicating directly with Providence Health Plan (PHP) Customer Service and PHP Members, PHP Network Pharmacies, and regulatory entities at the federal and state level

  • Communicate directly with pharmacists, nurses, physicians, and other health care providers and their staffs regarding medication management programs and initiatives

We welcome 100% remote work for residents of the State of Oregon and the city of Vancouver, WA.

Primary Responsibilities:

  • Coordinates and processes independently pharmacy prior authorizations taking into consideration pharmacy benefits, medication utilization policies, documented technician approval criteria, information submitted by prescriber, and age-related presentation of member requesting

  • Maintains pharmacy benefit member eligibility review process and database. Oversees point-of-service claims transactions processed on a daily basis through Argus Health System. Refers unusual occurrences to Argus Analyst/Coordinator

  • Takes, triages and documents incoming calls and requests, identifies and obtains resource for those requiring immediate attention, handles those appropriate through established protocols utilizing appropriate level of assessment and judgment

  • Performs intake and system data entry of information such as authorization and referral requests, patient information, discharge information, medication therapy management information, drug utilization management information. Uses sound judgment in identifying the need for clinical review or pharmacist/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures. Maintains the accuracy and integrity of the database

  • Determines and assigns appropriate and correct coding such as length of service, level of care, diagnosis and procedure, and system identifiers. Identifies medical cases for review by using ICD-9 and CPT-4 coding systems

  • Provides technical assistance and coding support to Clinical Reviewers by using PAS, ICD and CPT coding systems to ensure accurate diagnosis and procedure codes

  • Initiates information system search for needed documentation and information for cases and their review. Assists in the development and maintenance of loss reports

  • Notifies physicians and other prescribers of prior authorization and specific medication utilization issues, including communication of clinical status and documentation of such notification

  • Acts as department liaison and resource to members, Health Plan providers, and Health Plan departments to problem solve or address inquiries regarding work, workflow, processes, information system issues and relationships

  • Communicates with members, patients, network pharmacies and providers to obtain information, signatures and appropriate sign off in order to facilitate workflows. Develops written communications to prescribers and network pharmacies as directed

  • Audits processed pharmacy claims, system call documentation, and written correspondence for quality ensuring information is correct, complete, and clear

  • Communicates and serves as a resource to Customer Service, marketing staff, provider relations staff, pharmacies, physicians and others. Develops written communications such as frequently asked questions as needed

  • Trains and assists provider and office staff, members and payors, operations department and other Health Plan employees in UQM/RX processes and system usage as applicable. Serves as knowledge holder on pharmacy matters within the health plan and serves as a consultant as needed and within scope of position

  • Continuously monitors security and safety of medical records and medical information to protect confidentiality. Purges medical and other records as required according to established protocols

  • Reports statistical information on work unit activity. Collects and analyzes data and develops reports to indicate quality and effectiveness of work. Recommends and initiates change to ensure continuous quality improvement in work processes

  • Researches pended claims and authorizations or incomplete medical records and provides resolution or recommendations for solution

  • Identifies, notifies, documents and distributes information related pharmacy department work, and patient follow-ups, alerting the appropriate people as necessary

  • Authorizes payment of pharmacy claims and DMR's (direct member reimbursements) according to established departmental policies

  • Collects, organizes, reviews and verifies records submitted by prescribers and network pharmacies knowing that records are subject to both federal and state review and/or audit

  • Maintains sound working knowledge of all relevant policies and procedures. Develops written procedures for workflow processes

Required qualifications for this position include:

  • 2 years' experience as a pharmacy technician in a managed care environment -OR- 3 years' experience as a pharmacy technician in an outpatient pharmacy

  • Oregon Certified Pharmacy Technician License

Preferred qualifications for this position include:

  • Bachelor's Degree

  • National Certification as a Pharmacy Technician

Salary Range by Location:

Washington (Puget Sound, Vancouver), Oregon (Portland)

  • Min: $20.93

  • Max: $33.30

Oregon (Salem, Hood River, Medford, Seaside)

  • Min: $19.51

  • Max: $31.04

Eastern Washington (Richland, Spokane, Walla Walla)

  • Min: $18.63

  • Max: $ 29.63

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 152743
Company: Providence Jobs
Job Category: Clinical Quality
Job Function: Quality/Process Improvements
Job Schedule: Full time
Job Shift: Day
Career Track: Admin Support
Department: 5018 PHARMACY OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Pay Range: $20.93 - $33.30
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.