Pharmacy Technician, Utilization Management - Archimedes

Navitus Health Solutions / Lumicera Health Services; United States; Remote; USD 25,000 - 36,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program – up to $750

Job summary

Archimedes is seeking a Pharmacy Technician, Utilization Management to join our team remotely in the United States. The role supports first-level review of specialty medication prior authorizations, high-cost case management, and internal policy development.

You will interact with physicians, nurses, pharmacists, and members to obtain documentation and provide drug cost information. The position requires a high school diploma or GED and an active Pharmacy Technician license; hospital/managed

Qualifications

• High school diploma or GED is required.
• Licensed Pharmacy Technician.
• Pharmacy, Hospital, or Managed Care experience preferred.
• Participate in, adhere to, and support compliance program objectives.
• Ability to 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 documentation.
• Manage high-cost management and retroactive drug utilization cases and coordinate outreach.
• Manage queues for prior authorization, high-cost cases, claims editing, and clinical policy processes.
• Perform prior authorization case management for administrative denial and low-clinical acuity cases.
• Participate in special projects and process improvements to support priorities.
• Handle ticket work by tracking requests and ensuring timely resolution or escalation.
• Contact prescribers to obtain missing information for case reviews.
• Document outreach attempts and responses in applicable systems.
• Other duties as assigned.

Skills

Communication

Teamwork

Education

High school diploma or GED

Licensed Pharmacy Technician

Job description

Company

Archimedes

About Us

Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $0.00 - USD $0.00 /Hr.

STAR Bonus % (At Risk Maximum)

0.00 - Ineligible

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F: 8:00 am – 5:00 pm

Overview

Archimedes is seeking a Pharmacy Technician, Utilization Managementto 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

Location : Address

Remote

Location : Country

US