Clinical Pharmacy Technician

📋 Description

• The Clinical Pharmacy Technician is responsible for processing prior authorization requests, ensuring compliance with standards for accuracy, timeliness, productivity, and client performance commitments.

• Conducts analysis, gathers necessary information, and inputs prior authorization data essential for claims adjudication.

• Employs reasoning skills to identify deficiencies in information and make determinations regarding prior authorization processing based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).

• Engages with internal and external customers to both provide and gather information, ensuring exceptional service and quality delivery.

• Inputs prior authorizations into the system and prioritizes requests accordingly.

• Reviews formulary alternatives and takes into account previously tried and failed medications.

• Utilizes drug references to confirm that the requested medication is indicated and approved for the specific condition.

• Records all pertinent information related to the approval or denial of prior authorizations.

• Adheres to established roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making.

• Collaborates with assigned clinical pharmacists to ensure compliance with the defined boundaries and timelines of administrative processing.

• Investigates, researches, and resolves issues related to prior authorization processing, including making inquiries via written communication or telephone to gather information from clients, members, physicians, or pharmacies; seeking input from supervisors or clinical pharmacists; and referring unique or high-cost requests to supervisors as per guidelines.

• Coordinates outbound communication within the client system to members, physicians, and pharmacies as necessary to procure missing information and manage pending requests.

• Maintains thorough documentation of prior authorization-related information and statuses.

• Conducts outbound calls to gather information and respond to inquiries regarding prior authorization status.

• Safeguards and upholds the confidentiality and privacy of all prior authorization and member information, adhering to strict protocols for date stamping and the secure storage of prior authorization forms and related information.

• Identifies and proposes operational enhancements.

• Participates in and supports all relevant Quality Management initiatives.

• Maintains a flexible schedule to accommodate client needs as required.

• Complies with all policies and procedures.

• Accepts feedback and takes responsibility for performance.

• Adapts to the diverse needs of clients.

• Supports all activities related to the Compliance Program.

• Performs additional duties and responsibilities as assigned.

⛳️ Requirements

• Ability to thrive in a fast-paced, high-functioning environment while meeting deadlines and managing multiple high-priority tasks.

• Moderate-to-high level of knowledge regarding medications and disease states within the scope of pharmacy practice.

• Proficient in personal computer usage with high competency in Microsoft Word, Excel, Adobe, etc.

• Strong organizational skills with a keen attention to detail.

• Excellent verbal and written communication skills.

• Superior critical thinking abilities combined with a strong attention to detail.

• Outstanding customer service skills.

• Preferred: Minimum one year of experience with prior authorization.

• Preferred: Experience in a health plan or with a Pharmacy Benefit Manager.

🏝️ Benefits

• Healthcare, vision, and dental insurance.

• Generous 401k matching.

• Paid vacation.

• Personal time off.

• Holiday pay.

• Opportunities for growth and training.

• A team-oriented atmosphere with enjoyable events and prizes scheduled throughout the year.