Principal Associate analyzing Cyber controls and developing automated health metrics for Capital One. Collaborating with teams to transform telemetry data into real - time insights and prevent security risks.
About the role
- Pharmacy Technician Analyst overseeing and administering pharmacy benefits for Sutter Health's health plan services. Responsible for reviewing pharmacy-related appeals and educating members.
Responsibilities
- Oversee and administer pharmacy benefits for Sutter Health's value based pharmacy health plan services
- Serve as a pharmacy benefit and drug coverage subject matter expert
- Review pharmacy-related appeals and grievances by conducting clinical reviews
- Develop compliant administrative determinations
- Resolve escalated member issues
- Educate members and internal stakeholders on appropriate use of benefits and resources
- Support workflow and desk-level-procedure development, maintenance, and optimization
Requirements
- Graduate of an accredited pharmacy technician program
- PHARMC-Certified Pharmacy Technician
- 2 years recent relevant experience
- Knowledge of data fields required by NCPDP
- Ability at running ad hoc reports from pharmacy claims data
- Strong PC skills including PowerPoint, Access, Outlook, Excel and Word
- Knowledge of HIPAA, Health Care Reform, Business Code of Ethics and government regulated programs
- Ability to work collaboratively, prioritize functions, problem solve, and anticipate upcoming issues for the executives
Benefits
- Comprehensive benefits package
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