Pharmacy Technician - Medication Management, Prior Authorization

ccf; United States; Hybrid; USD 25,000 - 32,000; Full time

Job summary

Cleveland Clinic Health System is seeking a Pharmacy Technician for Medication Management and Prior Authorization. This remote-location role supports medication access and handles prior authorizations, claims processing, and patient communications with Ohio and Florida eligibility.

Training includes in-person sessions with periodic on-site meetings. Caregivers must reside in Ohio or Florida and will work 8-hour shifts, with no weekends or holidays.

Qualifications

• High School Diploma or GED required.
• CPhT certification through PTCB or NHA required at hire.
• Active Ohio Board of Pharmacy registration as CPT/RT/Pharmacy Technician Trainee required at hire and must update within 6 months.

Responsibilities

• Process prescription claims and initial benefits investigations.
• Assist with copay assistance programs and manufacturer co-pay cards.
• Handle prior authorization reviews and appeals for pharmacy claims.
• Manage patient communication for refills and appointments.
• Ensure accuracy of patient and prescription data across systems.
• Document all patient interactions in the pharmacy systems.

Education

High School Diploma/GED

Certified Pharmacy Technician (CPhT) – PTCB or NHA

Active OBOP registration as CPT/RT/Pharmacy Technician Trainee

Job description

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives - beginning with our own. That's the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Pharmacy Technician - Medication Management, Prior Authorization

Location

Cleveland

Facility

Remote Location

Department

Specialty Pharmacy-Pharmacy

Job Code

C99996

Shift

Days

Schedule

8:00am-4:30pm/7:30am-4:00pm

Job Summary

Job Details

**Applicants must reside in Ohio or Florida

Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world.

As a Pharmacy Technician in Medication Management and Prior Authorization, a caregiver in this work-from-home role will support medication access by processing prescription claims, conducting initial benefits investigations and assisting with copay assistance programs. Responsibilities include completing prior authorization chart reviews to identify medication changes, processing prescriptions in the computer system and managing incoming phone calls while balancing daily tasks. Training will be tailored to the caregiver's skills and experience, with opportunities for professional growth within Pharmacy and Cleveland Clinic.

There is an in-person training component and monthly on-site meeting requirement. Caregivers in Ohio and Florida are welcome to apply. Ohio based meetings will be at Beachwood administrative campus. Florida meetings would be located at the Florida Research and Innovation Center in Port St. Lucie.

A caregiver in this role will work 8-hour shifts between 7:30am to 4:00pm and 8:00am to 4:30pm, Monday through Friday. No weekends or holidays required.

A caregiver who excels in this role will:

• Initiate prior authorizations and communicate with third party payers on behalf of the physician and patient.
• Find and apply manufacturer co-pay cards and initiate patient assistance and co-pay assistance applications.
• Reach out to patients to manage refills and schedule necessary current and future assessments.
• Ensure the accuracy of prescription and patient data entered various systems by verifying patient, drug, quantities, directions, day's supply, insurance and physician data.
• Conduct a thorough benefits investigation and process any necessary prior authorizations and/or appeals for pharmacy claims.
• Explain benefit coverage and financial responsibilities to the patients.
• Supply financial assistance contact information and/or initiate patient assistance and copay assistance applications on behalf of the patients.
• Resolve aspects of specialty pharmacy insurances, including Medicare, Medicaid, Pharmacy Benefit Managers (PBM) and Preferred Provider Organizations (PPO) and communicate with payors and advise patients or physicians of results as needed.
• Utilize all pharmacy systems to review patient profiles, enter changes and establish assessment schedules.
• Document all patient/client/provider contact in appropriate computer systems.

Minimum qualifications for the ideal future caregiver include:

• High School Diploma/GED
• Upon hire, must be a Certified Pharmacy Technician (CPhT) through the Pharmacy Technician Certification Board (PTCB) or the National HealthCareer Association (NHA)
• Upon hire, it is required to hold an active registration through the Ohio Board of Pharmacy (OBOP) as either a Certified Pharmacy Technician, Registered Pharmacy Technician, or Pharmacy Technician Trainee.
• Caregivers with active Pharmacy Technician Trainee or Registered Pharmacy Technician registrations are required to update their registration to a Certified Pharmacy Technician registration with the OBOP within 6 months.

Preferred qualifications for the ideal future caregiver include:

• Completion of a formal pharmacy technician training program
• One year of experience in a pharmacy technician role

Physical Requirements:

• Typical physical demands include ability to perform the job while standing, reaching, stretching, stooping, and sitting for prolonged times.
• Manual dexterity sufficient to perform computer and dispensing functions of the job.
• Ability to lift up to 20pounds while walking, stooping, bending and reaching.

Personal Protective Equipment:

Follows standard precautions using personal protective equipment as required.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influen