Regulatory Pharmacy Technician

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 63,000 - 83,000; Full time

Job summary

A leading health plan is seeking a Regulatory Pharmacy Technician to oversee compliance for pharmacy and medical benefit programs. Responsibilities include collaboration with departments, regulatory reporting, and maintaining communication materials. The ideal candidate will have a pharmacy technician license and significant experience in pharmacy administration.

Qualifications

• Minimum of three years’ experience in pharmacy or claims processing.
• Active Certified Pharmacy Technician license in Rhode Island.

Responsibilities

• Ensure compliance with Medicare and Medicaid regulations.
• Collaborate with various departments for operational oversight.
• Conduct internal audits to ensure adherence to policies.

Skills

Analytical Skills

Communication

Prioritization

Problem Solving

Education

Certified Pharmacy Technician License

Pharmacy Administration Experience

Tools

Microsoft Office Suite

Job description

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Description

Under the direct supervision of the Manager of Regulatory Pharmacy and Oversight, the Regulatory Pharmacy Technician will provide oversight for Medicare, Medicaid, and Commercial-related pharmacy and medical benefit programs to ensure compliance with federal, state, and local laws, rules, and regulations. The primary responsibility is to ensure Neighborhood’s Pharmacy Benefit Manager (PBM) adheres to the administration of product benefit design for Medicare Part D, Commercial, and Medicaid drug benefits. Secondary responsibilities include oversight of medical benefit delegated services. This role will lead non-clinical oversight functions such as claim adjudication, coverage determination timelines, marketing materials, regulatory reporting, continuity of care regulations, member and provider letters, and support internal areas to meet pharmacy departmental regulatory requirements. The Regulatory Pharmacy Technician may also assist with day-to-day operational tasks, working closely with pharmacy technicians, pharmacists, and other departments as needed.

Duties and Responsibilities:

• Collaborate with departments such as Product, Grievance and Appeals, Compliance, Special Investigations Unit, Enrollment, and internal operations.
• Support vendor/FDR management for regulatory and operational oversight, including coverage determinations, benefit coding, marketing materials, and compliance of member/provider portals and communication templates.
• Assist in internal and external audits, ensuring regulatory deadlines are met, including after-hours work if necessary.
• Ensure compliance with accreditation and regulatory standards such as Medicare/CMS, NCQA, and state regulators.
• Support management of Corrective Action Plans (CAPs), audit responses, and compliance reporting, including Medicare and Medicaid requirements.
• Assist in developing and maintaining pharmacy communication materials for members and providers.
• Conduct internal audits to ensure adherence to procedures and policies.
• Maintain current and accurate pharmacy department webpages, including prior authorization criteria, policies, formulary, and other relevant information.
• Perform other duties as assigned.
• Ensure compliance with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, and applicable laws, reporting any unethical conduct.

Qualifications

Required:

• Active Certified Pharmacy Technician license in Rhode Island
• Minimum of three years’ experience in pharmacy, pharmacy administration, or claims processing
• Strong analytical skills
• Ability to work independently and resolve issues efficiently
• Excellent prioritization skills for multiple tasks and deadlines
• Effective verbal and written communication skills, including presentation abilities
• Intermediate to advanced proficiency in Microsoft Office Suite

Preferred:

• Active Certified Pharmacy Technician II license in Rhode Island
• At least one year of pharmacy managed care experience
• Experience with Medicare Part B and D regulatory compliance and oversight

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Insurance

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