Why The Health Plan of West Virginia
FY2024 · Form 990Its mission and biggest programs, as filedImproves community health and well-being through technology-driven services and professional partnerships.
- The Health Plan offers a managed care program for mountain Health trust (mht), West virginia's medicaid program. At december 31, 2024, the Health plan's mht Plan serviced 100,002 members with 42,679 members enrolled from the expansion population, 41,915 members enrolled…$501M spent in FY2024
- The Health Plan offers a medicare advantage program known as secure care and a program for members eligible for both medicare and medicaid known as a medicare dual special needs Plan (dsnp). Secure care enables the medicare eligible population to…$136M spent in FY2024
- The primary exempt purpose of the Health Plan of West virgina, INC. (the Health Plan) is to operate a state certified, federally qualified Health maintenance organization (hmo) which provides comprehensive Health care services on a prepaid basis. The number of…$124.3M spent in FY2024
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenThe Pharmacy Technician is responsible for answering member, pharmacy, and provider questions as well as researching and resolving problems, to help members understand and optimize the use of their pharmacy benefit. Pharmacy Technicians also work with pharmacists to help review drug coverage requests from members, physicians, and pharmacies to determine medication coverage based on benefit plan design, client specifics, clinical notes, and clinical criteria according to the utilization management system(s). Required: High School diploma or equivalent. National Pharmacy Technician Certification One year experience in a retail, hospital, managed care, or other similar pharmacy setting.
Minimum typing speed of 35 words per minute Demonstrate working knowledge of direct claims processing, pharmacy computer systems, spreadsheet applications (i.e., Microsoft Excel), phone system and other office/computer equipment as required. Knowledge of pharmaceutical generic and trade names. Ability to comprehend and follow established office routines, policies, and procedures. Effective oral and written communication skills, including grammar and spelling. Strong organizational skills, time management and multi-tasking abilities. Detail oriented with advanced analytical and problem-solving skills. Ability to work effectively as part of a team and independently.
Provide excellent customer service. Follow all plan policies and procedures. Desired: Degree in health-related field. Experience performing medication authorizations in pharmacy or managed care environment.
Responsibilities
Completes medication coverage requests through prior authorization criteria and escalates requests to Clinical Pharmacists or Medical Directors when requests require clinical review or is not approvable through the automated system. Contacts providers to obtain all necessary information for coverage requests prior to referring cases to Clinical Pharmacists or Medical Directors. Attaches relevant policy(ies) for the medication requests to the case documents prior to referring cases to Clinical Pharmacists or Medical Directors. Identifies and documents the relevant policy information prior to referring cases to a Clinical Pharmacist or Medical Director for review.
Resolves and documents coverage request outcomes in pharmacy benefit manager's system and communicates decision to physician's office and/or members through verbal and/or written notification in accordance with company policies. Researches, resolves, and documents physician or member inquiries and grievances and documents outcomes in the pharmacy benefit manager's system, medical review system or customer service tool in an accurate and timely manner. Provides verbal verification of member's plan eligibility and applicable pharmacy benefits. Utilizes pharmacy benefit manager and medical review system to update, modify and extract member information.
Details members and providers on pharmacy benefit inquiries such as formularies…
About The Health Plan of West Virginia
From its Form 990- Budget $772.7M
- Staff 643 · founded 1979
- Pays its leaders $241K–$691K (12 reported)
- Open jobs 19 · Jobs at The Health Plan of West Virginia · Full 990 report