Reviewer Jobs in Remote, OR (NOW HIRING)

PHARMACY TECHNICIAN 
 

Location: REMOTE
Employment Type: Full-Time, NON-EXEMPT
Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m.
Hourly Range: $23.67- $27.22
 

POSITION PURPOSE
 The Pharmacy Technician supports medical management functions, including utilization management, pharmacy management, and care coordination, by applying knowledge within assigned areas. This role ensures compliance with Umpqua Health Alliance policies and procedures, clinical practice guidelines, and applicable state and federal regulations. The Pharmacy Technician serves as a liaison between Oregon Health Plan members, providers, pharmacies, and community healthcare partners to support effective communication and coordination of care. Working under general supervision, this position performs standard clinical review and medical management support tasks to ensure accurate, timely, and compliant processing of pharmacy-related services.

ESSENTIAL JOB RESPONSIBILITIES

Regulatory Compliance:

• Maintains knowledge of Oregon Administrative Rules (Medicaid) governing coverage determinations. 
• Complies with organizational policies and procedures, Code of Conduct, Compliance Plan, and all applicable federal, state, and local regulations. 

Utilization Review:

• Performs initial reviews of pharmacy and medical service coverage requests and documents timely, accurate determinations. 
• Applies Health Evidence Review Commission Prioritized List of Health Services in coverage decisions. 
• Follows utilization management guidelines and meets inter-rater reliability (IRR) performance standards. 
• Evaluates medical necessity, cost, effectiveness, and appropriateness of services using claims data and clinical information. 
• Prepares cases for pharmacist review, including documentation of findings, benefit determinations, coding verification, supporting citations, care plans, risk assessments, and alternative treatment options.
• Communicates with provider regarding formulary options, prior authorizations, step therapy requirements, and applicable coverage criteria. 
• Perform accurate data entry into claims adjudication systems. 

Care Coordination:

• Supports Medication Management program activities, including outreach to members, pharmacies, and providers for Med Synch and scheduling coordination.
• Assists in resolving barriers to medication access and coordinating services across departments. 
• Educates members and providers on health plan benefits, rights, and responsibilities. 
• Collaborates with the Grievance and Appeals Coordinator regarding member concerns related to care or coverage. 
• Supports pharmacies in ensuring timely medication dispensing. 
• Performs other duties as assigned to support operational needs.

MINIMUM QUALIFICATIONS

• Current National and Oregon Certified Pharmacy Technician (CPhT) licensure.
• Minimum of one (1) year of experience as a pharmacy technician. 
• Fluent in pharmaceutical and medical terminology. 
• Proficient PC navigation skills, including Microsoft Office Suite (Word, Excel, Outlook), data entry, and internet research.
• Excellent critical thinking and time management skills with the ability to prioritize workload and meet turnaround times.
• Demonstrated ability to work independently and complete job duties proficiently
• Valid driver’s license and proof of current automobile insurance.
• Must notbe suspended, excluded, or debarred from participation in federal health care programs (e.g., Medicare/Medicaid).

PREFERRED QUALIFICATIONS

• Managed care experience
• Experience evaluating the impact of work across diverse communities, including communities of color, in technical analysis.
• Experience working in diverse team environments and across varying communication styles.
• Bilingual or translation capabilities preferred.

BENEFITS

Compensation based on skills, experience, and education.

Generous vacation PTO, sick leave, federal holidays, and birthday leave.

Medical, dental, and vision insurance.

401(k) with company match and immediate vesting.

Company-sponsored life insurance and additional benefits.

Fitness reimbursement program.

Tuition reimbursement and professional development opportunities.

WHY UMPQUA HEALTH?
 At Umpqua Health, every team member plays an important role in improving health, expanding access to care, and strengthening the communities we serve.
Inclusive Culture: We foster a respectful and inclusive environment where employees feel valued, supported, and empowered.
Growth & Development: We support continued learning through mentorship, career pathways, and professional development opportunities.
Work-Life Balance: We promote flexibility and well-being so employees can thrive professionally and personally.

EQUAL OPPORTUNITY EMPLOYER
 Umpqua Health is an equal opportunity employer committed to creating a respectful and inclusive workplace. Employment decisions are based on qualifications, merit, and business needs without regard to race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other status protected under federal, state, or local law.