Pharmacy Technician, Utilization Management - Archimedes

Archimedes; Madison (WI); Remote; USD 42,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental plan

Vision insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

FSAs

Education assistance

Referral bonus

Job summary

Archimedes is seeking a Pharmacy Technician, Utilization Management to join our team. This role focuses on first-level review of specialty medication prior authorizations, supporting high-cost case management and clinical policy development.

You will manage a queue for prior authorizations, benefit exclusions, formulary substitutions, and related tasks, communicating with prescribers and members to obtain missing documentation and cost information.

Qualifications

• High school diploma or GED required.
• Licensed Pharmacy Technician required.
• Pharmacy, Hospital, or Managed Care experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Develop and deliver follow up messages to physicians and members related to prior authorization and high-cost case management case documentation.
• Manage and act as primary point of contact for all high-cost management and retroactive drug utilization cases, related to coordination of outbound physician notification and inbound case documentation.
• Manage queues for pharmacy technician related work for prior authorization, high-cost cases, claims editing and clinical policy processes.
• Perform prior authorization case management related to administrative denial and low-clinical acuity cases as identified by clinical policies and guidelines.
• Participate in special projects, process improvement initiatives, and cross-functional assignments as needed to support departmental and organizational priorities.
• Manage assigned ticket work by monitoring requests, researching issues, documenting actions, and ensuring appropriate and timely resolution or escalation.
• Contact prescriber offices to request missing clinical information, supporting documentation, and other details needed to complete case reviews.
• Complete timely follow-up with prescriber offices and document outreach attempts, responses, and received information accurately within applicable systems.
• Other duties as assigned.

Skills

Licensed Pharmacy Technician

Pharmacy/Hospital/Managed Care

Compliance objectives

Interpersonal teamwork

Education

High school diploma or GED

Job description

Overview

Archimedes is seeking a Pharmacy Technician, Utilization Management to join our team!

The Pharmacy Technician, Utilization Management supports first-level review of specialty medication prior authorizations against clinical policies, high-cost case management functions, and internal clinical process development and maintenance activities. The role is responsible for managing an assigned work queue supporting both clinical and non‑clinical activities related to prior authorizations, benefit exclusions, formulary and therapeutic substitutions, and high‑cost case management.

The Pharmacy Technician, Utilization Management communicates with physicians, nurses, pharmacists, and members to obtain outstanding documentation, support patient medication history collection, and provide drug cost information for specialty and traditional medications.

Responsibilities

How do I make an impact on my team?

• Develop and deliver follow up messages to physicians and members related to prior authorization and high-cost case management case documentation.
• Manage and act as primary point of contact for all high-cost management and retroactive drug utilization cases, related to coordination of outbound physician notification and inbound case documentation.
• Manage queues for pharmacy technician related work for prior authorization, high-cost cases, claims editing and clinical policy processes.
• Perform prior authorization case management related to administrative denial and low-clinical acuity cases as identified by clinical policies and guidelines.
• Participate in special projects, process improvement initiatives, and cross-functional assignments as needed to support departmental and organizational priorities.
• Manage assigned ticket work by monitoring requests, researching issues, documenting actions, and ensuring appropriate and timely resolution or escalation.
• Contact prescriber offices to request missing clinical information, supporting documentation, and other details needed to complete case reviews.
• Complete timely follow-up with prescriber offices and document outreach attempts, responses, and received information accurately within applicable systems.
• Other duties as assigned.

Qualifications

What our team expects from you?

• High school diploma or GED required.
• Licensed Pharmacy Technician required.
• Pharmacy, Hospital, or Managed Care experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Archimedes?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.

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