Managed Care Pharmacy Technician

Excellus BCBS • De Witt, AR

17h • $21 - $33

About The Position

Under the direct supervision of a licensed pharmacist, the Managed Care Pharmacy Technician administers CDPHP member- and client-specific programs designed to optimize pharmacy benefits and the prescription process. The role handles live calls with members, physicians, and pharmacists to provide information about pharmacy benefits, formulary coverage, and CDPHP initiatives. It supports prior authorization initiatives under the guidance of a licensed pharmacist and implements and monitors technical aspects of pharmacy benefits, including processing medical exception requests using approved clinical algorithms. The position also advises on pharmacy matters raised by internal and external sources and performs ad hoc work supporting the Pharmacy department.

The Pharmacy Technician participates in a rotating on-call schedule, including holidays and evenings, alongside a utilization management pharmacist to support members with after-hours pharmacy issues. The role may require additional hours to meet turnaround-time responsibilities and a late shift on Fridays.

Requirements

• High school diploma and at least two years of experience in a health-related field.
• Basic understanding and interpretation of medical terminology and diagnosis codes.
• Basic understanding of drug classes and therapeutic interchange as described in drug policies.
• Clear understanding of prescription and medical benefits as they apply to the utilization review process.
• Proficient experience with the Microsoft Office suite.
• Strong verbal and written communication skills.
• Professionalism, a strong work ethic, and the ability to maintain a positive attitude when working with internal and external customers.
• Conscientiousness, efficiency, and accuracy in prior authorization, exception, and medical/Rx necessity review processing.
• Willingness to continually develop or refine skills needed to respond to customers.
• Strong customer service orientation and ability to interface effectively with internal and external customers.
• Ability to work independently and apply problem-solving and analytical abilities.
• Ability to cover rotating on-call responsibilities and a late shift on Fridays.
• Ability to work additional hours as needed to meet turnaround-time responsibilities.
• Ability to work for prolonged periods seated at a workstation using a computer.
• Ability to sit and/or stand at a workstation and use a monitor, keyboard, mouse, and/or phone for three or more hours at a time.
• Ability to work in a home-office environment for extended periods for business continuity.
• Ability to hear, understand, and speak clearly while using a phone, with or without a headset.

Nice To Haves

• Associate degree preferred.
• Pharmacy Technician certification (CPhT), LPN, or Medical Assistant/Technologist background strongly preferred.

Responsibilities

• Review medical exception requests using algorithms created by pharmacists.
• Review clinical documentation submitted by physicians and pharmacists against applicable criteria to determine prior authorization request approval.
• Assist with data entry and monitor or research member profiles for prior authorization requests and ad hoc reports.
• Provide telephone information to physicians and pharmacists about initiatives involving member prescriptions.
• Provide real-time authorization certification for prescription medication requests involving vacation supplies, duplication-of-therapy overrides, medication synchronization, and package-size issues.
• Implement formulary utilization management tools, including prior authorization, quantity limits, step therapy, dose optimization, and age or gender restrictions.
• Work with internal and external customers to identify, analyze, and resolve difficult situations, including Pharmacy benefit system issues.
• Research and resolve issues related to mail-order services, specialty pharmacy, or pharmacy claims processed in the Plan’s Facets system.
• Provide backup coverage for the Pharmacy Benefits Team phone queue as needed, assisting internal departments, external practitioners, and pharmacists with Pharmacy benefit questions and problems.
• Monitor and troubleshoot the Pharmacy Benefit Management (PBM) system and other pharmacy interfaces for eligibility, claims, and formulary issues, and conduct interface testing as necessary.
• Monitor production and quality improvement, and work with management and staff to support Pharmacy department quality standards.
• Establish productivity and quality standards in conjunction with the supervisor.
• Attend staff meetings and in-service programs as requested.
• Perform rotating on-call responsibilities, including holidays and evenings.
• Work additional hours as needed to meet turnaround-time responsibilities.
• Comply with CDPHP’s Corporate Compliance Policy and applicable laws, rules, regulations, and standards of conduct; report suspected violations through the stated reporting channels.
• Perform other duties as assigned.

Benefits

• Group health and/or dental insurance may be included in the total rewards package.
• Retirement plan may be included in the total rewards package.
• Wellness program may be included in the total rewards package.
• Paid time away from work may be included in the total rewards package.
• Paid holidays may be included in the total rewards package.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED