Pharmacy Technician II

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

📋 Description

• Evaluate prior authorization requests for both traditional and specialty medications related to members' pharmacy benefits.

• Communicate with providers via fax when necessary.

• Follow up with provider offices regarding any failed fax communications.

• Educate CareSource providers about available resources for formulary alternatives.

• Enter the appropriate prior authorizations into the prior authorization systems.

• Direct prior authorizations that need pharmacist review.

• Handle 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 relevant systems.

• Ensure that all fax, email, ePA, and other inquiries and submissions are addressed within state-mandated timeframes.

• Participate in special projects as required.

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

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

• Monitor workload aging and respond with the necessary urgency.

• Keep abreast of processes and protocols for all markets concerning faxes and phone communications.

• Comply with departmental and company policies and procedures.

• Execute other tasks as assigned.

⛳️ Requirements

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

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

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

• Proficiency in computer use within a “Windows” environment is required.

• Basic skills in Microsoft Word, Outlook, and Excel are needed.

• A typing speed of at least 40 words per minute (WPM) is necessary.

• Strong professional telephone communication skills are essential.

• Familiarity with medical terminology is required.

• Knowledge of medication names is important.

• Excellent communication skills when interacting with provider offices and pharmacies are a must.

• Ability to work both independently and collaboratively within a team setting.

• Capability to train and mentor new employees within the department.

• Keen attention to detail is required.

• Familiarity with the healthcare sector is a plus.

• Understanding of Medicaid/Marketplace is advantageous.

• Strong critical listening and thinking skills are necessary.

• Proper grammar usage is required.

• Time management skills are essential.

• Appropriate phone etiquette is important.

• A customer service-oriented mindset is expected.

• Decision-making and problem-solving abilities are required.

• Leadership skills and experience are preferred.

• Pharmacy Technician Certification is a plus.

• Ability to obtain state registration across multiple states, as needed.

• Availability to work any shift between 7 am and 9 pm is required.

• Flexibility to work weekends and overtime as required.

🏝️ Benefits

• Potential bonus linked to both company and individual performance.

• A comprehensive total rewards package.

• Employer investment in the overall well-being of employees.