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Job Information

University of Utah Health Health Plans Pharmacy Project Coordinator in Murray, Utah

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

This position is only for Health Plans. The Pharmacy Project Coordinator plays a critical role in providing administrative support to the Health Plans Pharmacy Management Program, including but not limited to, coordinating pharmacy utilization management, appeals and pended claims, assisting with pharmacy customer service, performing claims, contract and compliance audits, research projects involving pharmacy care management and savings opportunities, and managing provider updates with Pharmacy Vendors.

Corporate Overview: University of Utah Healthcare is an integrated academic healthcare system with four hospitals including a level 1 trauma center, twelve community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University Healthcare is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. This position is not responsible for providing care to patients.

Responsibilities

  • Coordinates requests for pharmacy utilization management, prior authorization, care management and appeals.

  • Manages pended medical pharmacy claims. Builds referrals in Epic using HCPCS criteria.

  • Resolves complex pharmacy customer service issues.

  • Audits program integrity within pharmacy department, operational functions, internal processes, claims system, vendors, provider contracts and compliance.

  • Monitors performance of pharmacy vendors.

  • Provides monthly updates to pharmacy vendor on additions/deletions of University of Utah Providers.

  • Coordinates and monitor monthly PA's for specialty drugs.

  • Provides excellent customer service to members, providers and all levels of internal staff.

  • Assists with research for pharmacy projects for cost savings and care management opportunities. Runs pharmacy reports and creates JIRA tickets as needed.

  • Manages/audits monthly recoveries on Healthy U "retro-term" claims and provide reporting.

  • Assists with preparation and communication for pharmacy meetings.

Knowledge / Skills / Abilities

  • Experience and knowledge with insurance plans, auditing, and/or compliance in a managed care setting or equivalent experience.

  • Ability to work under pressure, coordinate activities and manage multiple projects within deadlines.

  • Strong organizational, multi-tasking, time and project management skills.

  • Ability to handle highly sensitive and confidential issues in a professional manner.

  • Detail oriented with problem-solving abilities.

  • Ability to work both independently and as a team member.

  • Strong communication skills both verbally and in writing.

  • Proficient in use of Microsoft Word, Excel and Power Point.

Qualifications

Qualifications Required

  • Four years of applicable experience.

Licenses Required

  • Current Pharmacy Technician licensure in the State of Utah.

_

  • Additional license requirements as determined by the hiring department._

Qualifications (Preferred)

Preferred

  • Two years of experience in a managed care setting such as a health insurance company, HMO, PPO, ACO, TPA etc.

  • Experience with medical and/or pharmacy terminology.

  • Experience with claims processing and/or customer service.

  • Experience with government plans.

  • Bachelor's degree in a health related field, or equivalent work experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Manual Dexterity, Speaking

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EEO Statement

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.

Requisition Number 44170
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 8 to 5
Location Name University of Utah Health Plans
Patient Care? No
City Murray
State UT
Department UIP CST 01H UUHP PHARMACY SVC
Category Insurance / Health Plans

The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.

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