Pharmacy Technician, Prior Authorization

Devoted Health; Maryland; On-site; USD 43,000 - 55,000; Full time

Benefits offered by this job

Health, dental and vision plan

Paid time off

Mobile stipend

Stock options

Bonus eligibility

Parental leave

401K

Job summary

Devoted Health in Maryland is seeking a licensed Pharmacy Technician to support medical management operations for our health plan, focusing on outreach to providers and timely communication. The role emphasizes organization, detail-oriented work, and customer service to help members and clinicians.

Responsibilities include reviewing prior authorization requests, triaging provider submissions, obtaining clinical documentation, and communicating plan decisions to hospitals, providers, and members.

Qualifications

• Nationally Certified Pharmacy Technician (CPhT) with a minimum of three years in the field.
• Strong customer-service focus and ability to manage multiple tasks.
• Experience with Medicare Part B operations is preferred.

Responsibilities

• Review prior authorization requests and apply company policies and decision trees.
• Triaging and entering incoming prior authorization requests from provider offices.
• Communicate with hospitals and providers to obtain clinical documentation.
• Inform members and providers about clinical decisions and plan benefits.
• Provide operational support to enable pharmacists and physicians to work efficiently.
• Be the main point of contact for internal and external stakeholders.
• Support offshore clinical partners involved in workflows.

Skills

CPhT certification

Customer service

Detail-oriented

Multitasking

Tools

Gmail

G Suite

Job description

Job Description

A bit about this role: In this Pharmacy Technician role at Devoted you will support the medical management operations of the health plan. You'll be an important part of helping us build strong relationships with network health care providers through outreach and follow-up communication. This is a fast paced company that will come with ebb, flows and last minute changes. A successful candidate will be outgoing, detail-oriented and have a natural talent for customer service. We often require management of several tasks at once so enthusiasm and organization are key.

Your Responsibilities and Impact

• Reviewing and determining prior authorization requests based on company policies and decision trees.
• Triaging/entering incoming prior authorization requests from provider offices.
• Applying preferred product strategies and working with providers to steer utilization of our part B medication benefit.
• Reaching out to hospitals and provider offices to obtain important clinical documentation.
• Contacting provider groups and members to ensure communication of clinical decisions.
• Addressing questions and concerns from members when alternative treatment options are needed.
• Providing operational support for key medical management processes enabling yourself, pharmacists, and physicians to make efficient, high-quality decisions.
• Acting as the main point of contact for both internal and external stakeholders in our workflows.
• Providing support for offshore clinical partners who assist us in workflows.
• Interpreting plan benefits and entering specialty pharmacy overrides for proper claim adjudication.
• This role will be 11:30 to 8 PM EST
• Weekend Rotation is mandatory.

Required skills and experience

• Nationally Certified Pharmacy Technician (CPhT) with at least three years of work experience in this field.
• A strong desire to continue to work closely with aging patient populations.
• Experience with Medicare Part B operations (e.g. pharmacy help desk, utilization management, prior authorizations).
• Experience caring for Medicare patients.
• Proficient in technology - you'll be working in Gmail /G Suite.
• A history of being organized and having high attention to detail - it's the little things that matter.
• Prior experience in utilization management preferred.

Desired skills and experience

• Things move swiftly at a startup - enjoying a fast paced environment is key.
• Love the details and organizational skills are a strong-suit.
• Understanding urgency and having the ability to juggle multiple priorities.
• You're a problem solver by nature - schedules will change, things will come up, the printer will break, people will ask you for help.
• You can see the process and ways to make it better.
• Ability & agility to multitask - you may be asked to do several things and need to change plans mid day.
• Great communication skills - you'll be talking and faxing with providers, partners, and members.
• You feel accountable for the work you're responsible for.
• A calming presence - sometimes the days are 'hair on fire' and you'll be the person people turn to for support.

Salary Range

$20.90 - $26.25 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.