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Job Description:

This role can be remote and will need to work either CST or EST hours

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

• 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:

• Associates Degree

• CPharmacy Technician Certificate from PTCB

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

• 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.

• You are an independent self-starter and a strategic thinker who is eager to learn, improve, grow and demonstrate applied learning.

We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, retirement benefits, participation in the company’s equity program, paid time off, including vacation and sick leave. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. The expected salary range for this position is:

Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Covid 19 Update - Please Read:

Cityblock requires those hired into this position to provide proof that they have received the COVID-19 vaccine. Any individuals subject to this requirement may submit for consideration a request to be exempted from the requirement (based on a valid religious or medical reason) on forms to be provided by Cityblock. Such requests will be subject to review and approval by the Company, and exemptions will be granted only if the Company can provide a reasonable accommodation in relation to the requested exemption. Note that approvals for reasonable accommodations are reviewed and approved on a case-by-case basis and availability of a reasonable accommodation is not guaranteed. This vaccination requirement is based, in part, on recently established government requirements. The requirement is also based on the safety and effectiveness of the vaccine in protecting against COVID-19, and our shared responsibility for the health and safety of members, colleagues, and community.

The COVID-19 pandemic has severely impacted the health and lives of people around the world, including the vulnerable populations Cityblock serves. As a healthcare provider, Cityblock holds ourselves to the highest standards when promoting the health and safety of those who we serve. Given that the COVID-19 vaccines are one of the most powerful tools to fight this disease and save lives, Cityblock is implementing a COVID-19 booster mandate for Washington, D.C. employees under the guidance of local/state mandates.

Medical Clearance (for Member-Facing Roles):

You must complete Cityblock’s medical clearance requirements, which include, but may not be limited to, evidence of immunity to MMR, Hepatitis B, Varicella, and a TB screen, or have an approved medical or religious accommodation that precludes you from being vaccinated against these diseases.

We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.