Utilization Review Pharmacy Technician

Prime Therapeutics; Topeka (KS); On-site; USD 32,000 - 51,000; Full time

Job summary

Prime Therapeutics is seeking an Initial Review Pharmacy Technician to support utilization management for health plan customers. You will review requests for therapeutic appropriateness, determine reimbursement eligibility, and coordinate with physicians, patients, and pharmacies to gather necessary information.

In this role you will apply clinical criteria, document communication, and escalate complex cases to nurse or pharmacist as needed.

Qualifications

• Associate degree or higher in pharmacy tech or related field.
• 2+ years of pharmacy experience.
• Active state license/registration and national certification (PTCB/ExCPT) required.

Responsibilities

• Reviews patient information and checks appropriateness using clinical criteria; makes approval recommendations.
• Maintains utilization management principles and documents outcomes per policies.
• Contacts physicians/prescribers to obtain pertinent clinical history for reimbursement decisions.
• Escalates medical exception requests to nurse, pharmacist or physician when further review is needed.

Skills

Pharmacy experience

Clinical knowledge

Strong communication

Education

Associate's degree or related field

HS diploma or GED

Active state licensure/registration + national certification (PTCB/ExCPT)

Tools

PTCB/ExCPT certification

Job description

Prime Therapeutics is seeking an Initial Review Pharmacy Technician to support utilization management for health plan customers. You will review requests for therapeutic appropriateness, determine reimbursement eligibility, and coordinate with physicians, patients, and pharmacies to gather necessary information.

In this role you will apply clinical criteria, document communication, and escalate complex cases to nurse or pharmacist as needed.