Certified Pharmacy Technician

Job Title: Certified Pharmacy Technician (100% Remote)

Hours: M-F 10:00am - 7pm CST

Training Hours: M-F 8am - 5pm CST (4 weeks)

Certifications: Nationally Certified (PTCB) *required*

Job Summary:

We're a fully licensed health insurer. Our goal is to make healthcare simple, transparent, and human.

We are changing how health insurance works by creating a healthcare experience that's intuitive and puts people, not cost or workflows, first. We're using a consumer-focused and tech-driven approach to do so. This positions us uniquely in the space - and creates one of the biggest opportunities in healthcare.

We brought together leaders from top technology, service and healthcare companies to deliver on our promise and seize this opportunity. We all work side by side in a collaborative, energetic, and creative environment. The result: better people, better ideas, and better healthcare.

In this role, you will play an essential role in building our pharmacy utilization management function. The Clinical Review team is one of 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.

Skills:

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
• Learning and using vendor tools to create, process, and properly track pharmacy prior authorization requests
• 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
• Demonstrating the highest level of professionalism, accountability, and service in your interactions with teammates, customer service, providers, and members
• 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