About the Job General Summary of Position The Pharmacy Technician works under the direction of the health plan pharmacists to facilitate the safe and effective use of medications by enrollees/members and their providers. The Pharmacy Technician prioritizes the needs of enrollees/members and develops and sustains collaborative professional relationships. Primary Duties and Responsibilities Facilitates the accurate and timely processing of medication prior authorization requests.
Communicates with patients, providers, and dispensing pharmacies to support medication-related requests and other departmental initiatives. Collects all pertinent information for Medical Reviewers (Medical Directors and pharmacists) to complete medication prior authorization clinical evaluation. Pharmacy Operations activities including Reviewing and finalizing monthly, quarterly, and annual PBM reports.
Supports maintenance of PA metrics dashboard. Supports medication-related initiatives that align with strategic priorities with oversight from the Pharmacist. Activities may include but are not limited to outreaching to Enrollees/Members and Providers regarding HEDIS, EQRO or other quality measures.
Completes required regulatory reports that the health plan submits to the regulators. Performs administrative tasks as requested by the departmental leadership. Participates in the ongoing development and expansion of pharmacy initiatives, programs and continuous process improvement activities.
Develops standardized operating procedures and workflows. Supports case management and precertification team to facilitate overrides. Creates a pharmacy resource manual for the precertification team.
Assists with website content management. Provides polypharmacy follow-up support for patients. Required to have availability to provide on-call coverage for pharmacy prior authorization requests received outside of normal business hours on a rotating basis.
Acts as Subject Matter Expert to support interdepartmental projects. Minimal Qualifications Education High School Diploma or GED required Associate's degree preferred Experience 1-2 years experience as a pharmacy technician in an outpatient dispensing pharmacy required Experience supporting quality improvement goals with focus on HEDIS preferred Previous experience with prior authorization review processes preferred Previous use or knowledge of Cerner or MedConnect preferred Health Literacy Training preferred Health Equity Training preferred Licenses and Certifications LPT - Licensed Pharmacy Technician required upon hire This position has a hiring range of USD $19.55 - USD $34.25 /Hr.