HealthPartners is hiring a Pharmacy Navigator. This role navigates customers through our complex system by working across the health plan and care network to ensure customers receive and understand their pharmacy care/benefit options. This role is a customer-focused resource to anticipate, coordinate, solicit, respond and research customer needs related to pharmacy costs, benefits, accumulators, communications, changes, formulary status, appropriate medication options and coverage criteria. They will guide customers through HealthPartners pharmacy networks, internal & external medical resources, policies, procedures, online tools, etc. Act proactively on customers' behalf with complex benefits, referrals and prior authorization processes. This role provides strong support for our Medication Optimization initiative by acting as a part of the Medication Management Hub in which engagement, assessment and coordination of care for members identified with non-optimal medication use will take place.

ACCOUNTABILITIES: 

Work with all customers, including but not limited to; health plan members, clients, providers, vendors, internal staff, external providers, Medical Directors, etc.

Be available by phone, e-mail (or other means as applicable such as text, on-line chat, etc.) to respond to escalated concerns or consult requests from member services, pharmacy customer service or pharmacy staff on pharmacy benefits, medication questions or formulary changes. Work directly with members to resolve issues, educate and explain rationale for decisions.

Document contacts in appropriate system or database according to departmental policies.

Investigate and work with member rights and appeals around coverage determination challenges.

Advocate on customers behalf for prior authorizations; step therapy and other plan related processes. Use decision support methodology.

Train member services and pharmacy customer service staff on pharmacy benefits and formulary changes.

Analyze pharmacy complaints and inquiries, identify and advocate for solutions to prevent future occurrences.

Apply service recovery according to department policies.

Outreach to members (eg notification of coverage determinations, proactive communication of complex formulary changes and medication optimization support).

Support pharmacy quality and safety initiatives (eg medication adherence, recalls)

Maintain a working knowledge of tools that allow for assistance with formulary status of medications, current benefits, and options available.

 Support Medication Management Hub to increase engagement of identified at-risk members.

Facilitate coordination of care for at-risk members (Case Management, Disease Management, MTM, myMailRx Mail Order, Sync my Meds, Primary Care)

Reach out to and engage members identified to be at risk for medication related problems in HealthPartners services that will help to assure optimal medication use.

Perform other duties as assigned.

REQUIRED QUALIFICATIONS: 

Bachelor's degree in health care related field or equivalent Associates Degree with 3 years experience in a health care setting.

Pharmacy benefit and medication knowledge

Proficient customer service, care delivery, organizational and time management skills.

Excellent oral, written and interpersonal communication skills with the ability to establish and maintain working relationships across all levels of the organization.

Robust critical thinking problem solving and follow through skills.

Strong interpersonal skills and the ability to engage others.

Experienced with computer programs including but not limited to Microsoft Office (Word, Excel), Outlook, etc. Working knowledge of Internet based resources.

Must be self-motivated and able to function independently, taking independent action to facilitate resolution of customers' issues according to departmental procedures.

PREFERRED QUALIFICATIONS:

Nationally certified pharmacy technician

Pharmacy benefit management or managed care customer service experience employee.

Working knowledge of HealthPartners information systems, benefits, networks, policies & procedures, etc.

Advanced course work in computer programs such as Microsoft Office, Internet Explorer, etc.

Managed care experience such as prior authorizations

DECISION-MAKING

Must have the ability to work and make logical decisions independently according to department protocols.

Will provide decision support services to customers which include using decision aids, health coaching, and assessment of decision quality.

This decision making support includes:

provide the decision-maker with relevant information

help clarify the decision-maker’s preferences

present tradeoffs involved in choices

help resolve decisional conflict

making the correct connections with caregivers when appropriate