Clinical Pharmacy Technician I- Prior Authorizations

High Market Health; Wexford (Allegheny County); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading health network is seeking a Pharmacy Technician to support its centralized prior authorization department. The role involves reviewing requests, ensuring regulatory compliance, and liaising between providers and internal teams. Candidates should have a CPhT certification and two years of experience.

Benefits

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

Qualifications

• 2 years of experience as a Pharmacy Technician.
• Certified Pharmacy Technician (CPhT) certification required.

Responsibilities

• Reviews pharmacy utilization management coverage requests.
• Applies plan-specific benefits to coverage requests.
• Acts as a liaison between customer and corporate teams.

Skills

Pharmacy Technician

Regulatory Compliance

Customer Service

Education

Associate degree

Job description

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%)

• Maintains 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%)

• Performs 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 the Pharmacy Technician Certification Board.

Preferred

• Associate degree.

Language (Other than English):

None

Travel Requirement:

0% - 25%

Disclaimer: The job description is intended to indicate the general nature and essential duties and responsibilities of the work performed by employees within this job title. It may not contain a comprehensive list of all duties, responsibilities, and qualifications required to perform this job.

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

Employees may have access to confidential information and must comply with HIPAA and data security policies. All employees are responsible for adhering to the company's Code of Business Conduct and applicable laws and regulations.

Highmark Health and its affiliates prohibit discrimination and strive for accessibility. For assistance or accommodations, contact HR Services Online at [e-mail].