Pharmacy Tech III (US)

Elevance Health • San Juan, PR

2d • Hybrid

About The Position

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. This role requires associates to be in-office 1-2 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 virtual work, promoting a dynamic and adaptable workplace. This position will be based on PR-SAN JUAN, 1001 SAN ROBERTO ST, STE 101, 401 & 501. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

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

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

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