Pharmacy Utilization Review Technician

Prime Therapeutics; Lincoln (NE); On-site; USD 66,133,000 - 106,078,000; Full time

Job summary

Prime Therapeutics is seeking an Initial Review Pharmacy Technician in Lincoln, NE to support utilization management across health plans. You will review both prospective and retrospective requests for therapeutic appropriateness and determine medication reimbursement in collaboration with physicians, patients, and pharmacies.

The role requires active state licensure, 2+ years of pharmacy experience, and familiarity with clinical criteria, NCQA standards, and proprietary systems.

Qualifications

• 2+ years of Pharmacy Experience.
• Active pharmacy technician licensure or registration per state requirements.
• Must be eligible to work in the United States without the need for work visa or residency sponsorship.
• In states without licensure exams, must have active national certification (e.g., PTCB or ExCPT).
• Minimum of 2 years of pharmacy experience without a Bachelor’s degree OR 2 years with a Bachelor’s degree.

Responsibilities

• Reviews patient information and checks appropriateness using clinical criteria. Makes approval recommendations on all services that meet clinical review criteria.
• Adheres to utilization management policies and participates in ongoing training to ensure quality performance.
• Conducts Program Integrity Audits including outreach and review of medical records to audit authenticity of provider responses.
• Documents communications to physicians/prescribers and maintains edits and data elements that support the edits.
• Determines eligibility for medication reimbursement based on established criteria and records approvals or denials.
• Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team.
• Other duties as assigned.

Skills

Pharmacy experience

Computer literacy

Customer service

Education

Associate degree or equivalent

Bachelor’s degree in Science/Health/Medical

Job description

Prime Therapeutics is seeking an Initial Review Pharmacy Technician in Lincoln, NE to support utilization management across health plans. You will review both prospective and retrospective requests for therapeutic appropriateness and determine medication reimbursement in collaboration with physicians, patients, and pharmacies.

The role requires active state licensure, 2+ years of pharmacy experience, and familiarity with clinical criteria, NCQA standards, and proprietary systems.