University of Utah Health Care

  • Health Plans Pharmacy Project Coordinator

    Requisition Number
    29210
    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
    HEALTH PLANS CEO
    Category
    Insurance / Health Plans
  • 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.

    Responsibilities

    • Coordinate requests for pharmacy utilization management, prior authorization, care management and appeals.
    • Manage pended medical pharmacy claims. Build referrals in EPIC using HCPCS criteria.
    • Resolve complex pharmacy customer service issues.
    • Audit program integrity within pharmacy department, operational functions, internal processes, claims system, vendors, provider contracts and compliance.
    • Monitor performance of pharmacy vendors.
    • Provide monthly updates to pharmacy vendor on additions/deletions of University of Utah Providers.
    • Coordinate and monitor monthly PA’s for Specialty drugs.
    • Provide excellent customer service to members, providers and all levels of internal staff.
    • Assist with research for pharmacy projects for cost savings and care management opportunities. Run pharmacy reports and create JIRA tickets as needed.
    • Manage/audit monthly recoveries on Healthy U “retro-term” claims and provide reporting.
    • Assist 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' 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 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, Sitting, Speaking, Standing, Walking

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