UM Pharmacy Technician-1

Healthfirst; New York (NY); Hybrid; USD 40,000 - 55,000; Full time

Job summary

Healthfirst in New York is seeking a Pharmacy Technician to manage prior authorization requests for medications. This role involves assessing clinical information and ensuring compliance with regulations while maintaining professional communication with providers and members.

The ideal candidate should be a nationally certified Pharmacy Technician and possess strong verbal and written communication skills. This position is integral to a multidisciplinary team.

Qualifications

• High School Diploma or GED from an accredited institution.
• Nationally certified Pharmacy Technician in good standing or registered/lined Pharmacy Technician.
• Experience with prior authorization reviews and clear communication.

Responsibilities

• Review and assess prior authorization requests for medications.
• Communicate approval and denial decisions to providers and members.
• Ensure compliance with CMS and NYSDOH regulations.

Skills

Communication skills

Critical thinking

Customer service

Problem-solving

Bilingual (Chinese, Spanish, Russian)

Education

High School Diploma or GED

Certification as Pharmacy Technician

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

TruCare Care Management Platform

Job description

The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with provider offices and leverage strong communication and customer service skills when providing updates and delivering decision notifications to members and providers. The UM Pharmacy Technician position is part of a multidisciplinary team and works closely with providers, pharmacists, and medical directors.

Duties & Responsibilities

• Reviews prior authorization requests and units for medications requested under the medical benefit.
• Assesses provider‑submitted clinical information for clinical appropriateness based on predetermined clinical criteria.
• Sends notification to members and providers of authorization decisions via telephone, fax, or mail.
• Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH.
• Establishes great rapport with provider offices via telephonic communication.
• Sends request for information sheets to providers.
• Ensures that patient information is shared appropriately, maintaining confidentiality and compliance with federal law and HIPAA regulations.
• Performs additional duties as necessary.

Minimum Qualifications

• High School Diploma or GED from an accredited institution.
• Either nationally certified Pharmacy Technician in good standing (e.g. PTCB, NHA) or registered or licensed Pharmacy Technician in good standing.
• Experience conducting prior authorization reviews.
• Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional.

Preferred Qualifications

• Strong written and verbal communication skills in Chinese, Spanish, or Russian.
• Demonstrated critical thinking and problem‑solving skills.
• Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities.
• Knowledge of specialty pharmaceuticals and billing practices in the medical benefit.
• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to national and local coverage determinations.
• Proficient with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (pivot tables).
• Experience with TruCare Care Management Platform.

Compliance & Regulatory Responsibilities

Noted above (includes ensuring compliance with CMS and NYSDOH regulations, HIPAA, and related laws).

License/Certification

Nationally certified Pharmacy Technician in good standing (e.g. PTCB, NHA) or registered or licensed Pharmacy Technician in good standing.

Equal Opportunity Employer

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212‑519‑1798.