Pharmacy Tech III (US)

Elevance Health

1d • Hybrid

About The Position

Be Part of an Extraordinary Team Carelon is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By leveraging the power of new technologies, our strong, clinical-first lens and deep pharmacy expertise, we are actively defining our innovative role in the industry. Pharmacy Technician III Location: This role requires associates to be in-office [3] days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. This position will be based on PR-SAN JUAN, 1001 SAN ROBERTO ST, STE 101, 401 & 501. Schedule: This position will work an 8-hour from shift 8:00 am - 6:00 pm (AST) Monday to Friday. Additional hours may be necessary based on company needs. The Pharmacy Technician III is responsible for interpretation and data entry of complex prescriptions, prior authorization processing, and troubleshooting adjudication issues. Reviews requests by mail, telephone, or electronically and responds to inquiries and interprets requests to determine the most effective response. How you will make an impact. Primary duties may include, but are not limited to: Verifies member and provider information and inputs data for the pharmacists and other clinicians to review. Processes prior authorization requests from physicians’ offices and ensures compliance with all Medicaid, Commercial, and Medicare requirements; informs relevant parties of all prior authorization determinations. Managing inbound and outbound communications, triaging and problem-solving pharmacy inquiries, ensuring any related patient and prescriber communication is completed and resolving all related open cases across patient services tool and pharmacy processing system, and managing prescription queue workflow. Manage and support more complex inquiries and support other lower level pharm techs. Provides resolution to grievances and appeals issues. Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits. Manages escalations and analyzing data and results of any process improvements. Generates reports related to necessary data for respective department, as well as other ad hoc reports as needed. Works in applicable queues, supporting clinicians and operations leadership with inbound requests in all lines of business. Acting as a subject matter expert in all respective areas and lines of business and maintains knowledge of new tasks to ensure continued education and support. Mentors and trains lower-level pharmacy technicians as needed.

Requirements

• Requires H.S. diploma or equivalent and minimum of 5 years of pharmacy experience.
• Requires an active, valid, current and unrestricted state Pharmacy Technician license or national license based on applicable state(s) requirements to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.
• Multi-state certification is required if this individual is providing services in multiple states.

Nice To Haves

• For URAC accredited areas, the following professional competencies strongly preferred: strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Certified Pharmacy Technician preferred.

Responsibilities

• Verifies member and provider information and inputs data for the pharmacists and other clinicians to review.
• Processes prior authorization requests from physicians’ offices and ensures compliance with all Medicaid, Commercial, and Medicare requirements; informs relevant parties of all prior authorization determinations.
• Managing inbound and outbound communications, triaging and problem-solving pharmacy inquiries, ensuring any related patient and prescriber communication is completed and resolving all related open cases across patient services tool and pharmacy processing system, and managing prescription queue workflow.
• Manage and support more complex inquiries and support other lower level pharm techs.
• Provides resolution to grievances and appeals issues.
• Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.
• Manages escalations and analyzing data and results of any process improvements.
• Generates reports related to necessary data for respective department, as well as other ad hoc reports as needed.
• Works in applicable queues, supporting clinicians and operations leadership with inbound requests in all lines of business.
• Acting as a subject matter expert in all respective areas and lines of business and maintains knowledge of new tasks to ensure continued education and support.
• Mentors and trains lower-level pharmacy technicians as needed.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees