Pharmacy Member Experience Specialist

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Presbyterian is seeking a Pharmacy Member Experience Specialist

A Pharmacy Member Experience Specialist performs as a Presbyterian Pharmacy Services representative and as a Service Recovery Specialist and is responsible for providing customer service for members and providers for all PHP benefit plans. Specialists will ensure callers receive service excellence utilizing scripting, and critical thinking skills to assist with pharmacy questions or claims processing issues with regards to drugs and pharmaceuticals. The Pharmacy Member Experience Specialist will work to ensure members are highly satisfied with their prescription plan shown by improved Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, member satisfaction surveys and work to resolve any issues or concerns identified by our members. The emphasis is on providing patient-centered care to our members.

Some key responsibilities include:

• Act as a subject matter expert to quickly and accurately resolve any calls or inquiries received by our Pharmacy Benefit Manager (PBM)

• Help members navigate formulary changes negatively impacted them or received a denial such as finding alternatives or initiating exceptions

• Facilitate prescription refills between PCP, pharmacy, and health plan (keep member out of the middle)

• Help members find lower cost medications and help members avoid cost surprises

• Coordinate finding medications when shortages occur

• Facilitate mail order set up

• Make outreach to new members that ask for us to contact them to help transfer prescriptions

• Make outreach / accept transfers from service recovery team members that uncover a need around prescriptions

• Utilize data from Mock surveys, new employer group onboarding, new Medicaid, and Medicare onboarding for members to identify members for targeted outreach.

Qualifications:

• GED or High School diploma is required.

• Certified Pharmacy Technician-PTCB (CPHT-PTCB)

• Minimum of 1 year Retail Pharmacy experience preferred

• Minimum of 1-year Managed care customer service experience preferred

• Drug Information skills

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in ourPromise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.