Medicaid Pharmacy Case Manager 2025-01022
Medicaid Pharmacy Case Manager 2025-01022
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Job Description
Description and Functions
- GENERAL DESCRIPTION:
Open Until FilledWyoming Medicaid is looking for an experienced Certified Pharmacy Technician (CPhT) to serve as the Pharmacy Case Manager. This position performs pharmacy case management to decrease client and pharmacy fraud abuse and overutilization and assists in maximizing the efficiency and effectiveness of the Medicaid pharmacy program. The Pharmacy Case Manager also manages the Pharmacy LockIn Program and is involved with and responsible for various aspects of the administration of the Wyoming Medicaid prescription benefit.
Human Resource Contact:
ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed in the job level.- Pharmacy Case ManagementConducts research within the pharmacy and medical claims systems to review patient profiles and provider payment records to identify inappropriate drug utilization or questionable provider prescribing practices.
- Manage the Medicaid LockIn ProgramUses clinical knowledge regarding medication dosing drug interactions and contraindications as well as disease diagnosis history to identify clients meeting Pharmacy LockIn criteria. Administers the process to lock in clients to a single pharmacy for all Medicaid prescriptions.
- Pharmacy Utilization ReviewUses pharmacy technician expertise to answer questions and solve problems involving pharmacy claims and respond to inquiries from outside entities as needed. This includes inquiries from clients prescribers and pharmacies drug prior authorization inquiries and questions related to drug coverage.
- Medicaid Fraud and Abuse LiaisonCollaborates within the Wyoming Department of Health and with outside agencies as needed on issues pertaining to pharmacy fraud waste and abuse. This includes but is not limited to the Rx Abuse Stakeholders Board of Pharmacy Board of Medicine and Board of Nursing.
Qualifications
PREFERENCES:
Preference will be given to candidates with an active Pharmacy Technician license in the State of Wyoming and three 3 or more years of experience as a practicing pharmacy technician.
KNOWLEDGE:- Must be familiar with pharmaceuticals individual their therapeutic class dosage forms available strengths indications generic names contraindications and drug interactions.
- Must be familiar with medical terminology and have the ability to use available resources to refine and increase knowledge.
- Knowledge of the Medicaid program pharmacy benefit programs policies and regulations.
- Knowledge and understanding of Wyoming and Federal pharmacy law.
- Proficiency with Microsoft Office applications and Pharmacy Point of Sale systems.
- Must be able to prioritize cases and be able to identify when and to whom to make a referral.
- Must have excellent written and verbal communication skills as well as excellent customer service skills.
MINIMUM QUALIFICATIONS:Education:Bachelors Degree (typically in Records or Data Management)Experience:02 years of progressive work experience (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist IOREducation & ExperienceSubstitution:35 years of progressive work experience (typically in Records and Data Management) with acquired knowledge at the level of a Records & Data Management Specialist ICertificates Licenses Registrations:NoneNecessary Special Requirements
PHYSICAL WORKING CONDITIONS:- The employee may sit comfortably to perform the work; however there may be some walking standing bending carrying light items driving an automobile etc.
NOTES:- FLSA: NonExempt
- The Wyoming Department of Health is an EVerify employer.
- Certified Pharmacy Technician license in good standing in Wyoming required.
Supplemental Information
048Wyoming Department of Health Division of Healthcare Financing
Clickhere to view the State of Wyoming Classification and Pay Structure.
URL: State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.
Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.
Required Experience:
Manager
Employment Type
Full-Time
