Clinical Pharmacy Tech: Prior Authorization & DUR Expert

Health Partners Plans, Inc.; Jefferson Center (PA); On-site; USD 42,000 - 54,000; Full time

Job summary

Health Partners Plans, Inc. seeks a Certified Pharmacy Technician to support pharmacy operations in Philadelphia, PA. The role involves assisting with prior authorizations and responding to calls from physicians and pharmacy providers, helping with DUR analyses and formulary alternatives.

The position emphasizes accuracy, Medicaid/Medicare plan knowledge, and collaboration with Clinical Pharmacists to resolve processing errors and improve patient care.

Qualifications

• High School Diploma or GED
• 1 year of experience in pharmacy
• Familiar with managed care and delegated pharmacy services
• Excellent written and oral communication skills
• Self-motivated and a team player
• Proficient in Excel and relational databases such as MHS, CIC, DST, Macess
• CPhT certification

Responsibilities

• Able to work in a constant state of alertness and safe manner.
• Assist department in reaching call center goals based on productivity standards (e.g., calls answered within 30 seconds).
• Assist department in reaching call center goals based on quality standards (providing accurate information to physicians/pharmacies).
• Maintain knowledge of Medicaid/Medicare pharmacy benefit packages for providers and other departments.
• Assist Pharmacists in responding to physician/pharmacy calls, offer formulary alternatives, and resolve processing errors.
• Assist Pharmacists in reviewing clinical cases, researching medications, and notifying offices of approvals/denials of prior authorization requests.
• Interact with other departments to resolve pharmacy issues.
• Conduct clinical DUR on pharmacy claims and suggest recipient restrictions.
• Provide ideas to improve department quality and flow.
• May perform other duties as assigned.

Skills

Communication skills

Team player

Excel proficiency

Relational databases

Education

CPhT - Certified Pharmacy Technician

Tools

MHS

CIC

DST

Macess

Job description

Health Partners Plans, Inc. seeks a Certified Pharmacy Technician to support pharmacy operations in Philadelphia, PA. The role involves assisting with prior authorizations and responding to calls from physicians and pharmacy providers, helping with DUR analyses and formulary alternatives.

The position emphasizes accuracy, Medicaid/Medicare plan knowledge, and collaboration with Clinical Pharmacists to resolve processing errors and improve patient care.