Clinical Pharmacy Technician I- Prior Authorizations

Allegheny Health Network; Pittsburgh (Allegheny County); On-site; USD 40,000 - 50,000; Full time

Job summary

A leading healthcare provider is seeking a Clinical Pharmacy Technician I to support its centralized prior authorization department. This role involves reviewing pharmacy requests and ensuring compliance with regulations. Candidates should have 2 years of pharmacy technician experience and possess a valid certification. A $5,000 sign-on bonus is available for a one-year commitment.

Benefits

$5,000 sign-on bonus for 1-year commitment

Qualifications

• 2 years of experience as a Pharmacy Technician in a relevant setting is required.
• Certification as a Pharmacy Technician is mandatory.

Responsibilities

• Coordinates the pharmacy benefits prior authorization process.
• Maintains regulatory compliance and resolves cases within set timeframes.
• Engages in outreach to resolve member and provider issues.

Skills

Reviewing coverage requests

Resolving non-clinical issues

Coordinate pharmacy benefits

Education

Certification from Pharmacy Technician Certification Board (CPhT)

Associate degree

Job description

Clinical Pharmacy Technician I- Prior Authorizations

Join to apply for the Clinical Pharmacy Technician I- Prior Authorizations role at Allegheny Health Network

Clinical Pharmacy Technician I- Prior Authorizations

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Join to apply for the Clinical Pharmacy Technician I- Prior Authorizations role at Allegheny Health Network

• This position is eligible for a $5,000 sign on bonus for a 1-year commitment*
  
  

Company

Allegheny Health Network

Job Description

JOB SUMMARY

• This position is eligible for a $5,000 sign on bonus for a 1-year commitment*
  
  

This position supports the network centralized prior authorization department. Coordinates and administers the effective and efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy benefits are administered in accordance with all regulatory agency requirements

Essential Responsibilities

• Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required. (20%)
• Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines. (20%)
• Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department. (20%)
• Maintain regulatory compliance and resolves all cases within predetermined timeframes. (15%)
• Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary. (20%)
• Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others. (5%)
• May perform other non-clinical duties as required by management and department needs.
  
  

Qualifications

Required

• 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting
• Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board
  
  

Preferred

• Associate degree
  
  

Language (Other Than English)

None

Travel Requirement

0% - 25%

Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at [e-mail]

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Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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