Are you ready for new challenges and new opportunities?
Join our team!
AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all.
The Opportunity:
The position will support the processing and review of Prior Authorization/Coverage Determination requests, manage the Pharmacy help desk line, assist Customer Service on drug-related concerns/issues for the AlohaCare QUEST Integrated (QI) and Advantage Plus (ACAP) Plans, assist with quality related outreach, and provide administrative support for formulary management and compliance related functions of the AlohaCare Pharmacy Department.
Primary Duties and Responsibilities:
- Process and review all prior authorization (PA)/coverage determination (CD) requests in an accurate and timely manner.
- Adhere to turnaround times (TAT) for PAs/CDs as required by the Centers for Medicare & Medicaid Services (CMS), Med-QUEST (Hawaii Medicaid), and National Committee for Quality Assurance (NCQA).
- Assist members, pharmacies, prescribers, and internal staff with pharmacy claims processing, pharmacy benefits and overrides, and provide prior authorization request status.
- Review and process daily rejected claim and monitor claims processing for potential Fraud, Waste, and Abuse (FWA).
- Assist in administration of opioid “lock-in” program.
- Assist in the review of pharmacy oversight reports.
- Outreach to members to assist with medication adherence and other HEDIS/Medicare Part D related measures.
- Remain in compliance with the department’s policies and procedures.
- Other duties as assigned.
- Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.
Requirements:
- High school degree required, GED equivalent, or higher.
- Two (2) years of experience in Pharmacy or comparable education.
- Ability to type 45 words per minute (WPM).
- Ability to effectively communicate verbally/written and work as a team member with all associates in a professional and business manner.
- Must be customer service oriented and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
- Strong organizational, prioritization, communication, and mathematics skills.
- Time management, leadership and organizational skills.
- Strong desire to assist people.
Salary Range: $20.00 - $26.00 an hour.
AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws.
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