Green Key Resources is representing a health plan who is looking for multiple Certified Pharmacy Techs (Utilization Management) to join their team! This position is Monday - Friday day shift, no nights, weekends, holidays, or call! This is a remote role, you are able to work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
Hours of operation are 6 AM - 7 PM Central Time. Colleagues can define their schedule with their Team Lead but we expect the schedule to remain static week over week.
Position Summary:
Under the direction of the Supervisor, Pharmacy Utilization Management, the Pharmacy Utilization Management (UM) Technician is responsible for setting up cases in the various applications for drug prior authorization (PA) requests and performs daily quality checks to ensure compliance. The technician will run test claims once authorization are approved and reach out to members and providers as necessary.
Position Responsibilities:
Works with automated prior authorization (auto PA) tools to:
- Very administrative in nature - will be reviewing prior auth requests from fax, electronic, and inbound calls.
- Will review requests and checking them against pre-determined criteria - sending to Pharmacist for review
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
- Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Assists in the mentoring and training of new staff.
- Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
- Educates providers on how to submit claims and when/where to submit a treatment plan. Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
- Determine eligibility and screen incoming pharmacy prior authorization requests for all required documents
- Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
- Use Oscar and vendor tools to create, process, and properly track pharmacy prior authorization requests
- Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria
- Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
- Clearly document all communication and decision-making, ensuring a peer could easily reference and understand your decision
- Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for timeliness, content and accuracy
Minimum Qualifications:
- High School diploma or equivalent.
- Certified Pharmacy Technician (CPhT)
- Minimum of 2+ years of pharmacy experience, preferably in managed care setting or PBM.
- Proficient in MS Office-Excel, Word, and PowerPoint preferred
· Salary is based on experience, tenure, certifications etc. (very competitive with market place)
Next Steps:
Looking to interview immediately. If you feel that you meet these requirements and are interested, please APPLY
Job Type: Full-time
Benefits:
- Dental insurance
- Health insurance
- Tuition reimbursement
- Vision insurance
Schedule:
Application Question(s):
- What number should we call you at?
- What state do you reside in?
License/Certification:
- Pharmacy Technician Certification (Required)
Work Location: Remote