Clinical Associate – Pharmacy Technician Certification Required

This is a fully remote position, open to applicants in Texas.

📋 Description

• Assist the clinical team with reviews of prior authorization cases.

• Execute administrative responsibilities associated with prior authorizations and appeals.

• Provide support to member services, members, healthcare providers, and internal stakeholders in resolving claims, answering coverage inquiries, addressing formulary questions, and determining pharmacy benefits.

• Gather, verify, and document clinical data from providers, pharmacies, and members.

• Aid pharmacists in utilization management, making coverage decisions, and processing appeals.

• Oversee work queues to meet expectations for productivity, quality, and turnaround times.

• Process pharmacy claims and troubleshoot claim adjudication challenges.

• Investigate member eligibility, benefit coverage, and medication history.

• Liaise with prescribers, pharmacies, and members regarding the status of authorizations, coverage prerequisites, and alternative treatment options.

• Deliver customer service and address inquiries related to pharmacy benefits and medication coverage.

• Keep precise case documentation within pharmacy management systems.

• Assist in formulary management efforts, including step therapy and quantity limit programs.

• Ensure adherence to HIPAA regulations, client specifications, and other regulatory standards.

• Safeguard the confidentiality of protected health information.

• Support additional duties and special projects as assigned.

⛳️ Requirements

• Exceptional communication and interpersonal abilities, both written and verbal, with the capacity to adjust appropriately for various audiences.

• Capable of effectively managing multiple tasks, frequently shifting between them while maintaining focus despite interruptions.

• Proficient in computer applications, including Microsoft Office Suite.

• Experience in Pharmacy Benefit Management (PBM) is preferred.

• Team-oriented mentality with a strong sense of motivation and drive.

• A history of promoting collaboration, resolving conflicts, and managing projects is preferred.

• High school diploma or equivalent is required.

• Active Certified Pharmacy Technician (CPhT) certification.

• Ability to sit or stand for extended periods at a desk while working on a computer.

• Full-time position, Monday to Friday from 8 am to 5 pm CST.

🏝️ Benefits

• 401(k) with matching contributions.

• Dental insurance coverage.

• Health insurance benefits.

• Vision insurance options.

• Health savings account availability.

• Paid time off benefits.

• A high-growth environment with clear pathways for career advancement.

• A welcoming atmosphere and positive culture.