Temporary Pharmacy Tech-Utilization Management (Hybrid, CA)

Western Health Advantage; Sacramento (CA); Hybrid; USD 32,000 - 36,000; Full time

Job summary

Western Health Advantage in Sacramento, CA is seeking an experienced Temporary Pharmacy Technician to support utilization management activities at the health plan level. The role involves reviewing authorization requests, coordinating notifications, interpreting benefits, and supporting appeals within regulatory timeframes.

The ideal candidate has a CA Pharmacy Technician license, 3+ years of experience, and strong attention to detail.

Qualifications

• High school diploma or equivalent.
• At least three years of experience as a Pharmacy Technician.
• Two years of experience in a utilization management or managed care environment.
• A valid California Pharmacy Technician License in good standing.
• Customer service or call center experience is highly desired.
• Experience preparing professional business correspondence.
• Intermediate computer skills, including email, database systems, word processing, and spreadsheets.
• Strong attention to detail, organization, research, and problem-solving skills.
• Ability to communicate clearly and professionally with members, providers, Medical Groups, and internal departments.
• Ability to speak, read, write, and understand the primary language used in the workplace.

Responsibilities

• Review prescription medication authorization requests using established protocols and criteria.
• Refer questions outside criteria to a Clinical Pharmacist for review.
• Coordinate with the Pharmacy Coordinator and internal departments to finalize authorization decisions and notifications within regulatory timeframes.
• Prepare and send approval, authorization, and denial letters to members and providers.
• Research and prepare pharmacy cases for review by leadership and clinical staff.
• Assist with interpreting pharmacy benefits and prior authorization criteria for staff.
• Support research and resolution of pharmacy-related appeals and grievances.
• Maintain the Formulary Drug List and Prior Authorization criteria per committee decisions.
• Assist with audit activities including DMHC and NCQA reviews.
• Maintain current knowledge of medications and authorization requirements.
• Support provider and member notifications and other administrative tasks.
• Develop and maintain pharmacy policies and training materials.
• Mentor and train junior staff as needed.
• Provide coverage during holidays and peak times to ensure timely case completion.
• Perform additional duties and special projects as assigned.

Skills

Customer service

Communication skills

Attention to detail

Problem solving

Computer skills

Education

High school diploma or equivalent

California Pharmacy Technician License

Job description

Western Health Advantage in Sacramento, CA is seeking an experienced Temporary Pharmacy Technician to support utilization management activities at the health plan level. The role involves reviewing authorization requests, coordinating notifications, interpreting benefits, and supporting appeals within regulatory timeframes.

The ideal candidate has a CA Pharmacy Technician license, 3+ years of experience, and strong attention to detail.