Managed Care Pharmacy Tech: Prior Authorization & Benefits

Capital District Physicians Health Plan Inc; Jamestown (NY); On-site; USD 29,000 - 45,000; Full time

Job summary

Capital District Physicians Health Plan Inc (CDPHP) seeks a Managed Care Pharmacy Technician to support member and provider programs, explain formulary coverage, and assist with prior authorization under a pharmacist's supervision. The role includes live calls, data entry, and participating in on-call rotations to support after-hours pharmacy issues.

You will monitor pharmacy benefits, assist with benefits processing in the Facets system, and collaborate with internal and external customers to

Qualifications

• High school diploma or equivalent with health-related experience.
• Pharmacy Technician certification preferred (CPhT).
• Strong understanding of medical terminology and benefits.

Responsibilities

• Review medical exception requests based on pharmacist algorithms.
• Assess prior authorization requests against criteria.
• Data entry and monitoring of member profiles for requests and reports.
• Provide telephone information to physicians and pharmacists about initiatives.
• Provide real-time authorization certification for prescriptions and related requests.
• Implement formulary utilization tools (prior auth, quantity limits, step therapy).
• Collaborate with internal/external customers to resolve system issues related to benefits.
• Research and resolve mail-order, specialty, or formulary issues in the Facets system.
• Back up Pharmacy Benefits Team phone queue coverage as needed.
• Monitor PBM interfaces for eligibility, claims, and formulary issues; perform testing.
• Support quality improvement and productivity standards with management.

Skills

Customer service

Verbal communication

Written communication

Analytical skills

Education

High school diploma

CPhT Certification

Associates degree preferred

Tools

Microsoft Office

Job description

Capital District Physicians Health Plan Inc (CDPHP) seeks a Managed Care Pharmacy Technician to support member and provider programs, explain formulary coverage, and assist with prior authorization under a pharmacist's supervision. The role includes live calls, data entry, and participating in on-call rotations to support after-hours pharmacy issues.

You will monitor pharmacy benefits, assist with benefits processing in the Facets system, and collaborate with internal and external customers to