UM Pharmacy Technician-1

Healthfirst., Inc.; United States; On-site; USD 41,101 - 64,338; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Incentive and recognition programs

401(k) contributions

Job summary

JobRx, Inc. seeks a UM Pharmacy Technician responsible for reviewing prior authorization requests for medications under the medical benefit. The role requires strong communication skills and the ability to make approval decisions based on clinical criteria.

Candidates should possess a High School Diploma or GED and be nationally certified as a Pharmacy Technician. The position offers competitive compensation ranging from $41,101 to $64,338 based on location, along with comprehensive health benefits.

Qualifications

• Nationally certified Pharmacy Technician in good standing or registered/licensed.
• Experience conducting prior authorization reviews.
• Experience requiring professional communication.

Responsibilities

• Review prior authorization requests for medications.
• Assess clinical information for appropriateness.
• Notify members and providers of authorization decisions.

Skills

Strong written and verbal communication skills

Critical thinking and problem-solving

Team player

Education

High School Diploma or GED

Nationally certified Pharmacy Technician

Tools

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

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
• Additional duties as necessary

Qualifications

Minimum Qualifications:

• High School Diploma or GED from an accredited institution
• Either nationally certified Pharmacy Technician in good standing (i.e., 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
• PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
• Experience with TruCare Care Management Platform

License / Certification

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

Compensation & Benefits

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $64,338
• All Other Locations (within approved locations): $41,101 - $60,320

In addition to your salary, Healthfirst offers employees a full range of benefits such as medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401(k) contributions (all benefits are subject to eligibility requirements).

Equal Employment Opportunity Statement

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. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.