Pharmacy Technician II

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

📋 Description

• Evaluate prior authorization requests for traditional and specialty medications related to members’ pharmacy benefits that are submitted by healthcare providers.

• Dispatch fax communications to providers as needed.

• Reach out to provider offices to follow up on any unsuccessful fax transmissions.

• Inform CareSource providers about available resources that detail formulary alternatives.

• Input prior authorizations into the relevant prior authorization system(s) when approval is warranted.

• Initiate the routing of prior authorizations that necessitate pharmacist review.

• Respond to provider inquiries concerning prior authorization requests, prescription coverage, and formulary matters.

• Conduct outbound calls to gather information from providers and/or pharmacies.

• Record all telephonic interactions in the designated systems.

• Ensure that fax, email, ePA, and other submissions are addressed within the state-mandated timeframe.

• Engage in special projects as assigned by management when required.

• Handle calls and resolve issues from retail and specialty pharmacies.

• Support Case Managers, Member, and Provider Services with pharmacy-related concerns, overrides, and inquiries.

• Monitor the aging of current workloads and respond with the necessary urgency.

• Maintain an understanding of processes and procedures for all markets regarding faxes and phone communications.

• Comply with departmental and company policies and procedures.

• Execute additional job responsibilities as requested.

⛳️ Requirements

• A High School Diploma or equivalent relevant work experience is mandatory.

• A preference for candidates with three (3) years of experience in retail pharmacy or hospital pharmacy.

• One (1) year of experience in managed care prior authorization is preferred.

• Proficient in computer use with knowledge of a “Windows” environment.

• Basic proficiency in Microsoft Word, Outlook, and Excel.

• Ability to type at a minimum speed of 40 words per minute (WPM).

• Strong professional telephone communication skills.

• Familiarity with medical terminology is essential.

• Knowledge of medication names is required.

• Excellent communication abilities when interacting with provider offices and pharmacies.

• Capability to work independently as well as collaboratively within a team setting.

• Ability to train and mentor new employees in the department.

• Strong attention to detail.

• Understanding of the healthcare sector.

• Knowledge of Medicaid/Marketplace regulations is a plus.

• Strong critical listening and thinking skills.

• Proficient use of grammar.

• Effective time management skills.

• Appropriate phone etiquette.

• Customer service-oriented mindset.

• Skills in decision making and problem solving.

• Leadership experience and capabilities are preferred.

• Pharmacy Technician Certification is advantageous.

• Ability to obtain state registration in multiple states as required.

• Willingness to work any shift between 7 AM and 9 PM.

• Flexibility to work weekends and overtime as necessary.

🏝️ Benefits

• Bonus linked to both company and individual performance.

• Comprehensive and substantial total rewards package.

• Support for employee total well-being.