Washington State Pharmacy Authorization Coordinator (MAPS 2/CQCT) in Olympia, Washington
Pharmacy Authorization Coordinator (MAPS 2)
This position is the primary point of contact within the Pharmacy Policy Section for policy questions from Pharmacy Authorization staff. If you have knowledge of methods of research, analysis, and report writing at an independent level with medical/pharmacy claims data, this may be the opportunity for you!
Position Objective: The Pharmacy Authorization Coordinator reports to the Pharmacy Operations Manager and is responsible for oversight and management of all operational aspects to support prior authorization and utilization management. This position is responsible for resolving pharmacy prior authorization access issues. They independently evaluate clinical criteria and uses it to design, develop, implement, and monitor prior authorization programs. The Pharmacy Authorization Coordinator develops, oversees, monitors, evaluates, and administers clinical initiatives within the Outpatient Prescription Drug Program, including oversight and review of work performed by other divisions for the implementation of WAC, promulgation of policy, and enforcement of policy through Pharmacy Point of Sale authorization processing rules.
*Some of what you will do: * Pharmacy Authorization Coordination:
- Ensures timely review of authorization requests for prescription drugs and identifies opportunities to increase 1st level review by authorization staff.
- Ensures timely resolution of access issues related to prescription drug authorizations.
- Provides oral and written guidance to the Pharmacy Authorization unit in response to policy questions.
Creates, updates, and reviews documents used by the Pharmacy Authorization unit. This includes authorization pend forms, denial letter language, drug/drug class processes, and rolodex entries and materials to reflect clinical and program intent. Coordinate implementation of clinical policies, new prior authorization initiatives, and updates to the Apple Health Preferred Drug List (AHPDL):
Analyzes clinical policies and separates out 1st and 2nd level review criteria. Creates new or updates existing authorization pend forms to reflect new or changes to existing policy authorization criteria.
- Determines impact to Pharmacy Authorization unit materials and is responsible for ensuring accurate and timely updates. Resolve stakeholder complaints.
*Required Qualifications: *
A Bachelor’s degree and two years of experience as a Financial Services Specialist 5 or as a WorkFirstSupervisor OR
A Master’s degree with major study in public health, public administration, social work, or closely related fieldand two years of supervisory or consultative experience in health services, social services, or Medicaidprograms OR
One year as a Medical Assistance Program Specialist 1 Additional qualifying experience may substitute year for year, for required education or supervisory experience. Preferred/Desired Qualifications: Two years of experience with claims processing, billing, authorization, or data analysis in an NCPDP compliant Pharmacy Point of Service claims processing system or medical claim management system are required, and will be considered substitutable for other qualifying experience. Licensed Pharmacy Technician Knowledge of pharmacy industry and prescription drug terminology; Knowledge of and experience with current NCPDP transactional standards; Knowledge of and experience with Excel, Word, and Decision Support applications; Knowledge of Federal and state laws and regulations, related to Medicaid and health care, with particular emphasis in the optional provision of pharmacy benefits within Medicaid according to section 1927 of the SSA; Knowledge of continuous quality improvement practices; Knowledge of methods of practice of research, analysis, and report writing at an independent level.
ABOUT HCA The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
What we have to offer:
- Meaningful work with friendly co-workers who care about those we serve Voices of HCA
- A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values
- A healthy work/life balance, including alternative/flexible schedules and mobile work options.
- Infants in the workplace Infants at the Workplace Video
- A great total compensation and benefit package WA State Government Benefits
- _A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. _
- Tuition reimbursement.
- And free parking! About Olympia and Washington State Washington State offers a total work/life package of pay, benefits, flexibility, and workplace opportunities to help you get the most out of your career and out of life. Washington State is a great place to work, play, and be a part of a community, offering quality of life that is unsurpassed. From the high energy urban center of Seattle, one of the nation's top ranked cities, to the more relaxed pace of our rural communities, Washington's distinctive Northwest lifestyle blends a progressive, creative culture with a casual nature.
*How to Apply: * Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile and attach:
- A cover letter that specifically addresses how you meet the qualifications for this position.
- Current resume.
- Three professional references, including a minimum of one past supervisor. If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1180 or email Sanyu.Tushabe@hca.wa.gov.
*Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position. *
Salary: $55,524.00 - $72,756.00 Annually
Location: Thurston County – Olympia, WA
Job Type: Full Time - Permanent
Department: Health Care Authority
Job Number: 2021-01528
Agency: State of Washington
Address: View Job Posting for Agency Information View Job Posting for Location, Washington, 98504
Phone: View Posting for Agency Contact