Remote Pharmacy Technician – Care Coordination & Compliance

Umpqua Health; Roseburg (OR); Remote; USD 33,000 - 36,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) with company match

Paid vacation and holidays

Sick leave and birthday leave

Tuition reimbursement

Job summary

Umpqua Health is seeking a Pharmacy Technician to support medical management functions, including utilization management, pharmacy management, and care coordination. The role supports Oregon Health Plan members, providers, pharmacies, and community partners while ensuring compliant processing of pharmacy-related services.

The position emphasizes regulatory compliance, coordination of care, and education of members on plan benefits.

Qualifications

• Current National and Oregon Certified Pharmacy Technician (CPHT) licensure.
• Minimum of one (1) year of experience as a pharmacy technician.
• Fluent in pharmaceutical and medical terminology.
• Proficient PC navigation skills, including Microsoft Office Suite (Word, Excel, Outlook), data entry, and internet research.
• Excellent critical thinking and time management skills with the ability to prioritize workload and meet turnaround times.
• Demonstrated ability to work independently and complete job duties proficiently.

Responsibilities

• Maintains knowledge of Oregon Administrative Rules (Medicaid) governing coverage determinations.
• Complies with organizational policies and procedures, Code of Conduct, Compliance Plan, and all applicable federal, state, and local regulations.
• Performs initial reviews of pharmacy and medical service coverage requests and documents timely, accurate determinations.
• Applies Health Evidence Review Commission Prioritized List of Health Services in coverage decisions.
• Follows utilization management guidelines and meets inter-rater reliability (IRR) performance standards.
• Evaluates medical necessity, cost, effectiveness, and appropriateness of services using claims data and clinical information.
• Prepares cases for pharmacist review, including documentation of findings, benefit determinations, coding verification, supporting citations, care plans, risk assessments, and alternative treatment options.
• Communicates with providers regarding formulary options, prior authorizations, step therapy requirements, and applicable coverage criteria.
• Supports Medication Management program activities, including outreach to members, pharmacies, and providers for Med Synch and scheduling coordination.
• Assists in resolving barriers to medication access and coordinating services across departments.
• Educates members and providers on health plan benefits, rights, and responsibilities.
• Collaborates with the Grievance and Appeals Coordinator regarding member concerns related to care or coverage.
• Supports pharmacies in ensuring timely medication dispensing.
• Performs other duties as assigned to support operational needs.

Skills

Pharmaceutical terminology

Time management

Independent work

Critical thinking

Driver’s license

Education

CPHT licensure (National and Oregon)

Tools

Microsoft Office Suite

Job description

Umpqua Health is seeking a Pharmacy Technician to support medical management functions, including utilization management, pharmacy management, and care coordination. The role supports Oregon Health Plan members, providers, pharmacies, and community partners while ensuring compliant processing of pharmacy-related services.

The position emphasizes regulatory compliance, coordination of care, and education of members on plan benefits.