Utilization Management Pharmacy Technician

Associate’s or Bachelor’s degree preferred
1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting. Or 1-2 years experience working in a mail order or specialty pharmacy
Active Certified Pharmacy Technician (CPhT)
Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service
Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.

Support all lines of business via facilitating the process for utilization management requests for coverage, entering authorizations into the claims platform, and facilitating member and provider communications
Provides support to members enrolled in specialty management programs, including coordinating any needed prior authorization with the UM team, the fulfillment of the prescription with the specialty pharmacy partner, enrollment in patient assistance programs, and billing questions.
Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases
Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
Participate in the quality review and inter-rater reliability processes
Provider call center: answer prescriber inquiries about the status UM requests
Ensures regulatory and privacy standards are consistently met.

Associate’s or Bachelor’s degree preferred
1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting. Or 1-2 years experience working in a mail order or specialty pharmacy