Clinical Pharmacy Technician

Job Overview

Motivated by Purpose. Powered by Clinical Expertise. Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people. WE OFFER A competitive compensation package. Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays. Growth and training opportunities.

Job Description

A team atmosphere with fun events and prizes scheduled throughout the year.

Position Summary Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.

Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication.

Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc. ).

Roles Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines.

Check formulary alternatives and review tried and failed medications. Utilize drug references and verify the drug being requested is indicated and approved for the condition. Document all related information regarding the PA approval or non-approval.

Key Responsibilities

• Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.
• Accountable for achieving prior authorization processing productivity and accuracy standards Major Responsibilities or Assigned Duties Enter prior authorizations into the system and prioritize requests.
• Conform to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making.
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Participate in and support all applicable Quality Management initiatives Maintain a flexible schedule to meet client needs, as needed Adhere to all policies and procedures Take feedback and responsibility for performance Adapt to the differences of clients Support all Compliance Program activities Complete other duties and responsibilities as directed Position Levels Each level attained compounds responsibilities with those of prior level(s).
• Clinical Pharmacy Technician I: Production should increase regularly, from 1-3 to 7 Prod steps/hour Quality should increase regularly, with expected minimum rate of 95% Clinical Pharmacy Technician II: 3-month Production average should meet or exceed 7 Prod steps/hour (100%) 3-month Quality average should meet or exceed 96% No PIPs or CAPs in prior 3 months for any reason Completed all training checklists for department and demonstrated proficiency with position processes and PG clients Participate in the weekend rotation process Proficient with all position processes and team clients’ expectations Demonstrate ability to create training documents/presentations Clinical Pharmacy Technician III: 3-month Production average should meet or exceed 8.3 Prod steps/hour (118%) 6-month Quality average should meet or exceed 98% No PIPs or CAPs in prior 6 months for any reason Effectively manage PANF reports, daily assignments, LOI, and Outreach calls Demonstrate problem solving and ability to work cross-functionally for new projects and HQs Demonstrate ability to train other PACs on HQ/processes and provide constructive feedback Effectively assist with monthly audits when asked Correctly approve PAC I-II Overdollar requests, as well as own Participate in special projects, lead committees, or pilot new processes/improvements Clinical Pharmacy Technician IV: 3-month Production average should meet or exceed 9.7 Prod steps/hour (138%) Effectively regularly assist with monthly audits and calibration calls Cross trained on RxAdvance process/system and capable of filling in at any time Participate in the weekend rotation and weekend leadership on-call process Effectively train and mentor new hires from day 1 overview to end of 120 days, including weekly training meetings Participate in the Customer Advocate Program Effectively cover the floor without a supervisor, including for escalated calls or emails Requirements Skills and Experience Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Strong organizational skills with attention to detail Strong oral and written communication skills Excellent critical thinking capabilities with a strong attention to detail Exceptional customer service skills Minimum one-year prior authorization experience preferred Health plan or Pharmacy Benefit Manager experience preferred Education High school diploma or equivalent Active Certified Pharmacy Technician (State or National License) Work Environment: Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.

Required Skills and Qualifications

• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Clinical Pharmacy Technician I: Production should increase regularly, from 1-3 to 7 Prod steps/hour Quality should increase regularly, with expected minimum rate of 95% Clinical Pharmacy Technician II: 3-month Production average should meet or exceed 7 Prod steps/hour (100%) 3-month Quality average should meet or exceed 96% No PIPs or CAPs in prior 3 months for any reason Completed all training checklists for department and demonstrated proficiency with position processes and PG clients Participate in the weekend rotation process Proficient with all position processes and team clients’ expectations Demonstrate ability to create training documents/presentations Clinical Pharmacy Technician III: 3-month Production average should meet or exceed 8.3 Prod steps/hour (118%) 6-month Quality average should meet or exceed 98% No PIPs or CAPs in prior 6 months for any reason Effectively manage PANF reports, daily assignments, LOI, and Outreach calls Demonstrate problem solving and ability to work cross-functionally for new projects and HQs Demonstrate ability to train other PACs on HQ/processes and provide constructive feedback Effectively assist with monthly audits when asked Correctly approve PAC I-II Overdollar requests, as well as own Participate in special projects, lead committees, or pilot new processes/improvements Clinical Pharmacy Technician IV: 3-month Production average should meet or exceed 9.7 Prod steps/hour (138%) Effectively regularly assist with monthly audits and calibration calls Cross trained on RxAdvance process/system and capable of filling in at any time Participate in the weekend rotation and weekend leadership on-call process Effectively train and mentor new hires from day 1 overview to end of 120 days, including weekly training meetings Participate in the Customer Advocate Program Effectively cover the floor without a supervisor, including for escalated calls or emails Requirements Skills and Experience Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc.
• Strong organizational skills with attention to detail Strong oral and written communication skills Excellent critical thinking capabilities with a strong attention to detail Exceptional customer service skills Minimum one-year prior authorization experience preferred Health plan or Pharmacy Benefit Manager experience preferred Education High school diploma or equivalent Active Certified Pharmacy Technician (State or National License) Work Environment: Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.
• All candidates are required to pass a Background Screen before beginning employment.
• Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

Benefits and Perks

• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Strong organizational skills with attention to detail Strong oral and written communication skills Excellent critical thinking capabilities with a strong attention to detail Exceptional customer service skills Minimum one-year prior authorization experience preferred Health plan or Pharmacy Benefit Manager experience preferred Education High school diploma or equivalent Active Certified Pharmacy Technician (State or National License) Work Environment: Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.

Work Location and Schedule

This role is listed as Remote USA with location information shown as Remote USA. The employment type is Full Time.

About the Company

Medical Review Institute of America is the organization connected with this listing. USAJobs.Today displays this opportunity for job discovery only, so applicants should verify company details, application instructions, and eligibility on the official employer website.