Pharmacy Tech I- Clinical Programs

WellDyne•Lakeland, FL

12d

About The Position

Pharmacy Tech I supports WellManaged and other clinical solutions within the Clinical Solutions team. The role supports inbound and outbound calls with members and providers, prior authorization operations, and other clinical program activities. The technician follows policies and procedures related to clinical reviews and serves as a client service liaison for prior authorization, while also participating in training. Success requires strong analytical, communication, problem-solving, and decision-making skills, attention to detail, effective time management, and proficiency with Microsoft applications. The position reviews clinical prior authorization requests against protocols to determine medical necessity, handles provider questions and requests for additional information, and routes denials to a clinical pharmacist for final review. It also supports appeals, maintains accurate clinical program trackers, ensures approvals are processed correctly and promptly, communicates outcomes in compliance with applicable requirements, assists with prior authorization and step-therapy system design and build, and generates reports for operational support and oversight. The role requires Pharmacy Technician Certification, at least two years of pharmacy-related experience, and at least two years of customer-service-related experience. The position is in a typical office environment and involves prolonged sitting at a computer, along with operating standard office and phone equipment.

Requirements

Pharmacy Technician Certification.
At least 2 years of pharmacy-related experience.
At least 2 years of customer-service-related experience.
Knowledge of the MS Office Suite and ability to learn new and complex computer system applications.
Strong telephone, verbal, and written communication skills.
Time-management skills.
Teamwork and team-building skills.
Ability to work independently within a team environment with little direct supervision.
Analytical skills.
Problem-solving and decision-making skills.
Ability to remain focused and productive when tasks are repetitive.
Strong attention to detail and effective follow-up skills.
Ability to multitask.
Claim system knowledge.
PA Hub knowledge.
General Microsoft product knowledge, including Excel and SharePoint.
Positive attitude and excellent customer-service mindset.
Computer proficiency to navigate required databases and operate required software packages.
Demonstrated ability to handle problems tactfully.

Responsibilities

Review clinical prior authorization requests based on protocols to determine medical necessity.
Answer provider questions appropriately based on submitted clinical information.
Request additional information from providers as needed for review.
Direct all prior authorization denials to a clinical pharmacist for final review.
Assist with managing appeals.
Update clinical program trackers to accurately track clinical interventions and member and provider communications.
Ensure prior authorization approvals are placed correctly and in a timely manner.
Communicate approval and denial outcomes to providers and members as appropriate and in compliance with state, federal, and accreditation requirements.
Participate in the design and build of prior authorization and step therapy within key systems.
Run and generate reports supporting operational activities and oversight.
Serve as a subject matter expert liaison with client services.
Participate in training.
Apply appropriate policies, procedures, and eligibility and benefit policies.
Maintain confidentiality of protected health information in compliance with state and federal law.
Meet established productivity, schedule-adherence, and quality standards while maintaining good attendance.
Perform other duties as assigned.