Remote Pharmacy Utilization Support Technician

DG GLASS & TRADE - Desde 2001 conectando negocios confiaveis.; Hart's Location (NH); À distance; USD 25 000 - 36 000; Temps partiel

Résumé du poste

DG GLASS & TRADE - Desde 2001 conectando negocios confiaveis. seeks a full remote Utilization Support Technician to support UM requests, enter authorizations, and communicate with members and providers in the US.

Responsibilities include coordinating with Pharmacy technicians, Pharmacists, and Medical Directors, performing outbound provider calls, and ensuring compliance with regulatory and privacy standards while delivering concierge-level service.

Qualifications

• 1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting.
• Or 1-2 years experience working in a mail order or specialty pharmacy
• Active Certified Pharmacy Technician (CPhT)
• Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service.
• Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.
• High school diploma or equivalent
• Background check required

Responsabilités

• Support all lines of business via facilitating the process for utilization management requests for coverage, entering authorizations into the claims platform, and facilitating member and provider communications
• Provides support to members enrolled in specialty management programs, including coordinating any needed prior authorization with the UM team, the fulfillment of the prescription with the specialty pharmacy partner, enrollment in patient assistance programs, and billing questions.
• Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
• Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases
• Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
• Participate in the quality review and inter-rater reliability processes
• Provider call center: answer prescriber inquiries about the status UM requests
• Ensures regulatory and privacy standards are consistently met.

Connaissances

Pharmacy technician experience

PBM experience

Active CPhT

Detail-oriented

Communication skills

Multi-tasking

Formation

High school diploma

Description du poste

DG GLASS & TRADE - Desde 2001 conectando negocios confiaveis. seeks a full remote Utilization Support Technician to support UM requests, enter authorizations, and communicate with members and providers in the US.

Responsibilities include coordinating with Pharmacy technicians, Pharmacists, and Medical Directors, performing outbound provider calls, and ensuring compliance with regulatory and privacy standards while delivering concierge-level service.