Pharmacy Tech I- Clinical Programs

WellDyne•Lakeland, FL

12d•Onsite

About The Position

Pharmacy Tech I supports WellManaged and other clinical solutions within the Clinical Solutions team. The technician supports inbound and outbound calls with members and providers, other clinical program activities, prior authorization operations, and client service related to prior authorization. The role follows policies and procedures for clinical reviews and participates in training. The technician reviews clinical prior authorization requests against protocols to determine medical necessity, handles questions and requests for additional information, supports appeals, and ensures approvals and communications are accurate, timely, and compliant with applicable requirements. The role also maintains clinical program tracking, supports reporting and system configuration activities, serves as a subject matter expert liaison with client services, and maintains the confidentiality of protected health information. This position requires strong analytical, communication, problem-solving, and decision-making skills; attention to detail; effective time management; and proficiency with Microsoft applications. The work takes place in a typical office environment and involves prolonged computer use.

Requirements

Pharmacy Technician Certification.
At least 2 years of pharmacy-related experience.
At least 2 years of customer service-related experience.
Knowledge of Microsoft 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 may be 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 questions appropriately based on clinical information submitted by providers and request additional information as needed.
Direct 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, 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.