Do you want to join a company that is dedicated to improving the health and well-being of the people and communities we serve?
Do you want to join a company that believes in a personal approach to health care right in your community?
The Pharmacy Techinican: will play an essential role in building our pharmacy utilization management function. The Clinical Review team is one of our most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding and helping to grow our pharmacy utilization management program and driving high quality reviews.
The Pharmacy Technician will:
- As a Pharmacy Technician/Pharmacy Processor, dedicated to high quality pharmacy decision-making and improving the member and provider experience, you'll be responsible for:
- Determining eligibility and screening incoming pharmacy prior authorization requests for all required documents
- Preparing, organizing, and distributing pharmacy prior authorization requests for review by pharmacist/physician and responding to pharmacist/physician requests for additional information
- Collecting relevant medical information (via telephone, fax, and portal) and applying the appropriate PA criteria
- Meeting required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
- Clearly documenting all communication and decision-making, ensuring a peer could easily reference and understand your decision
- Communicating oral and written prior authorization outcome notifications that comply with standards and requirements for timeliness, content and accuracy
- Participating in quality improvement activities as requested
- Developing a working familiarity with applicable regulatory and accreditation requirements
- Providing support on regulatory audits and quality accreditation surveys, as needed
- Supporting the team prepare for expansion into new markets, as needed
Required Qualifications of a Pharmacy Technician:
- 1-2 Years of Telephonic Experience in a Pharmacy Technician setting
- Active Pharmacy Technician or Pharmacy Technician Trainee License