Pharmacy Technician, Utilization Management - Archimedes

Archimedes; United States; Remote; USD 27,552,000 - 41,328,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending Account

Educational assistance

Professional membership assistance

Referral bonus

Job summary

Archimedes is seeking a Pharmacy Technician, Utilization Management to join our team. You will support first-level reviews of specialty medication prior authorizations and manage high-cost cases in alignment with clinical policies.

You will coordinate with physicians, nurses, and pharmacists to obtain missing documentation and provide drug cost information for specialty and traditional medications, while maintaining timely communication with prescribers.

Qualifications

• High school diploma or GED required.
• Licensed Pharmacy Technician with valid license.
• Experience in Pharmacy, Hospital, or Managed Care preferred.
• Ability to adhere to compliance program objectives.

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, including outbound physician notification and inbound case documentation.
• Manage queues for pharmacy technician work related to 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 policies and guidelines.
• Participate in special projects, process improvement initiatives, and cross-functional assignments.
• Manage assigned ticket work by monitoring requests, researching issues, documenting actions, and ensuring timely resolution or escalation.
• Contact prescriber offices to request missing clinical information and supporting documentation needed to complete case reviews.
• Document outreach attempts and responses accurately within applicable systems.
• Other duties as assigned.

Skills

Licensed Pharmacy Technician

Prior authorization

Communication

Team collaboration

Education

High school diploma or GED

Job description

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.

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 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 s upport 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!

Location : Address

Remote

Location : Country

US