Our client in Orlando, FL is looking for a Clinical Pharmacy Technician This is a long term consulting position. If interested, Please apply to this ad or send your resume and contact details with the job #793924 and job title in the subject line to and firstname.lastname@example.org also can call 617-586-1131
Position: Clinical Pharmacy Technician
This position plays a key role in medical and pharmacy management initiatives critical to ICORE/Magellan Pharmacy Services in achieving revenue goals and operational objectives. This position is responsible for executing specialty injectable utilization management programs on behalf of health plan/payor customers. This role is often the first point of contact that a Provider’s office or Specialty Pharmacy has when initiating an authorization for injectable or infused product. The position requires communication and teamwork across all internal ICORE/Magellan departments (Account Management, Specialty Pharmacy, IT, Project Management, Quality), as well as health plan/payor departments (medical management, pharmacy management) and an in-depth understanding of all specialty injectable therapeutic classes, products, trends, current management techniques and industry guidelines. The UM Specialist provides outstanding customer service while also achieving department performance metrics.
- On behalf of health plan clients, manages all prior authorization requests for specialty injectable medications, ensuring appropriate injectable product selection, step-edit management, therapeutic protocol adherement, medication dosing adjustments, assay management, concomitant medication prescribing and specialty pharmacy selection.
- Maximize ICORE specialty pharmacy medication dispenses via execution of UM protocols. Proactively suggest the use of ICORE for providers and/or members in an “Any Willing Provider” state and those who are not required to use ICORE Pharmacy exclusively. Ensure that the appropriate documentation is sent to ICORE Pharmacy in a timely manner. Provide communication to ICORE Pharmacy staff on status of authorization as needed.
- Utilize ICOREAuth and other platforms ensuring all cases are accurately entered and documented. Continuously monitor the status of unresolved cases via intra-day reporting methods and ensure they are resolved in a timely manner. Ensure that authorization requests for non-preferred products are correctly routed within ICOREAuth and provider outreach has taken place to educate on Plan’s preferred formulary.
- Manages all case information, paperwork and supportive documentation required for completion of authorization process and successful claims processing. Ensure that the health plan receives daily ATE report and Issue Logs where applicable. Perform updates to cases within ICOREAuth once plan has provided a final determination.
- As the end user and system expert, proactively suggest changes/updates to the prior auth application that ensures maximum protocol adherement, suggest processes to help improve overall efficiency and increased health plan customer satisfaction.
Education: HS Degree/GED required
Experience: 2+ Years minimum experience required
Field(s) of study: Pharmacy Technician certification preferred (CPhT). Must be registered in the State in Florida. Must remain in good standing.
Industry: Specialty or retail pharmacy experience, previous reimbursement experience, and/or working in a health plan/health care setting.
Job Specific: Experience as Pharmacy Tech, Utilization Management or Customer Service in a high-volume, multi-functional call center environment.
An equivalent combination of experience and education is acceptable.
Schedule: Monday - Friday 8am-6pm (manager will confirm schedule once hired)
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc). Highly effective verbal and written communication skills.
Computer Skills: proficient in Microsoft Office, Outlook, Excel
Licenses, Certifications, etc.: Certified Pharmacy Technician (CPhT) and Registration with the State of Florida Board.