Pharmacy Services TechnicianLooking for candidates within Idaho, but the right candidate will be eligible for a remote role within our 4-state footprint (WA, ID, OR, and UT).Primary Job PurposeThe Pharmacy Services Technician is a corporate-wide technical support resource for pharmacy benefit, reimbursement, and other drug use issues which do not require clinical judgment. This function assists the Clinical Pharmacy Consultants and Pharmacy Services staff with formulary-related operations and other operational processes which require knowledge and experience with pharmaceuticals.Normally to be proficient in the competencies listed below:Pharmacy Services Technician would have a high school diploma or related certificate and five years of experience as a pharmacy services technician in a retail, hospital, or other licensed pharmacy setting or equivalent combination of education and experience. Pharm tech certificate may be substituted for two years of experience.Responsibilities:Performs all duties as described in this document unless doing so would require clinical judgement. In any situation in which clinical judgment is necessary, the Pharmacy Services Technician will seek assistance from appropriate medical personnel. Appropriate medical personnel will be available for support during normal business hours.Responds to non-clinical pharmacy issues from providers, pharmacy services staff, case managers, preauthorization nurses, ENCC personnel, and government programs personnel and customer service. These pharmacy issues include formulary drug coverage, appeal and reconsideration claim status, and pricing for drug claims.Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals. Prepares reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation, including, but not limited to medical chart notes/reports and medication profiles. Communicates (orally and by written documentation) information and determinations to providers and members as necessary.Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants. Organizing data includes but is not limited to sorting drugs into appropriate therapeutic and generic categories.Assists with auditing and investigations of medication-related claims, cases, and providers to identify misuse of medications, misuse of (Regence HMO Oregon) resources, substance abuse, and erroneous and fraudulent billing practices. Investigates and organizes workflow for claims referred to Pharmacy Services for review and allowable determination (misc. J codes, providers on review, reconsiderations).Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement.Contributes to and supports the corporation's quality initiatives through process improvement teams and by encouraging team and individual contributions toward the corporation's quality improvement efforts.Minimum Requirements:Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS and HIPAA regulations.Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy.Knowledge of general office practices and procedures.Demonstrated knowledge of grammar and techniques of business practice.Ability to interact effectively with a variety of health care professionals, including physicians, nurses, pharmacists, and billing staff both internally and externally.Demonstrate maturity, tact, diplomacy, and persuasiveness.Demonstrated ability to perform pharmaceutical pricing calculations.Ability to type 30 words per minute, 60 wpm preferred.Demonstrated ability to operate a variety of standard business machines including calculators, copiers, and faxes.Basic computer programs skills (Word, Excel, etc.).Ability to organize, plan, and prioritize daily workflow and projects within time constraints.Experience with health insurance and/or prescription benefits preferred.Work Environment:Work primarily performed in an in-home environment.May be required to work overtime.The base pay annual salary range for this job is $18.80 - $34.10/hour,depending on candidate's geographic location and experience.The annual incentive payment target for this position is 5%.Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:medical, dental, and vision coverage for employees and their eligible family membersannual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)paid time off varying by role and tenure in addition to 10 company holidaysup to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)one-time furniture and equipment allowance for employees working from homeup to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Spend Advisor - Nurse

symplr, Boise

Overview To support one symplr in assisting our customers with managing spend related to technologies in use within both acute care and hospital setting by gathering, analyzing, and interpreting gathered data. Duties & Responsibilities Conduct daily analyses of submitted quotes from member facilities Maintain and cleanse surgical pricing databases on a regular basis to keep up with changes in markets and/or products and services Update any self-serve reports within the symplr website to ensure relevance and accuracy Remain educated on assigned technology and/or subject matter including trends and changes over time Review and finalize analysis and recommendations and deliver to clients Meet with industry vendors as requested Consult with clients regarding recommendations which may include live discussions or email interactions Coach and advise clients on how to best interact with symplr products Interact with other members of the surgical team Develop content and deliver webinars, white papers, blog posts and other media to educate clients and market symplr products Skills Required Strong written and verbal communication skills Strong interpersonal / team focused skills Basic computer skills (MS Office, proficiency in Excel) Analytical and strong attention to detail Proactive, effective communication and interpersonal skills necessary to collaborate in cross-functional teams as well as to engage as part of a remote team Customer focused Qualifications Required: Minimum 3-5 years of nursing experience in acute setting Registered Nurse (LVN or LPN acceptable) Experience with medical equipment, such as patient monitoring, infusion pumps, telemetry monitoring, nurse call, defibrillators, dialysis, etc. Clinical experience in any of the following nursing specialties: ICU, Stepdown, PACU, Telemetry, ER, Med-Surg Exposure to equipment or consumables purchasing process within unit Clinical coordinator preferred MinUSD $65,000.00/Yr. MaxUSD $85,000.00/Yr.