Visiting Nurse Service of New York d/b/a VNS Health

Compensation

Full Description

Overview Supports Pharmacy Services Specialists and Director of Pharmacy Services to perform Quality Improvement interventions, including maintenance of data integrity, member outreach and reporting to fulfill other regulatory requirements. Works under moderate supervision. What We Provide Referral bonus opportunities Personal and financial wellness programs Opportunities for professional growth and career advancement What You Will Do Receives, downloads, reformats and reviews data in daily claims files and reports. Conducts preliminary audit of data and screens for potential issues. Addresses non-clinical operational issues as a result of report review, and alerts pharmacist to clinical follow up when needed. Prepares electronic files and creates Coverage Determination and Redetermination packages for pharmacist’s and Medical Director’s review. Reviews on-going PBM reports under pharmacist’s supervision. Addresses non-clinical issues and alerts pharmacist to needed clinical follow up. Performs quality checks of Formulary files prior to DOH or CMS submission. Compares files to identify and resolve discrepancies and/or missing information. Assists pharmacist with maintaining and tracking spreadsheets including obtaining, input and retrieval of prescription and related information. Conducts member outreach. Contacts members using standard script to assist with processing prescriptions, resolving copayment or ID card questions. Provides customer service and follow up on issues. Assists with retail pharmacy outreach. Contacts pharmacies to gather information and to resolve pharmacy benefit coverage and prescription eligibility and claim problems. Assists with physician/prescriber outreach. Contacts physicians’/prescribers’ offices to assist with drug Prior Authorization initiation procedures. Participates in on-going auditing/monitoring activities. Participates in special projects and performs other duties as assigned. Qualifications Licenses and Certifications: NYS Pharmacy Technician Certificate required Education: High School Diploma or the equivalent required Work Experience: At least one year of pharmacy experience required Managed Care Experience preferred Bi-lingual (Spanish) preferred Proficiency in Microsoft Office (Word, Excel, PowerPoint) required Pay Range USD $20.98 - USD $26.23 /Hr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.