Pharmacy Technician, Prior Authorization

Devoted Health • Waltham, MA

3d • $21 - $26

About The Position

In this Pharmacy Technician role at Devoted you will support the medical management operations of the health plan. You’ll be an important part of helping us build strong relationships with network health care providers through outreach and follow-up communication. This is a fast paced company that will come with ebb, flows and last minute changes. A successful candidate will be outgoing, detail-oriented and have a natural talent for customer service. We often require management of several tasks at once so enthusiasm and organization are key.

Requirements

• Nationally Certified Pharmacy Technician (CPhT) with at least three years of work experience in this field.
• A strong desire to continue to work closely with aging patient populations.
• Experience with Medicare Part B operations (e.g. pharmacy help desk, utilization management, prior authorizations).
• Experience caring for Medicare patients.
• Proficient in technology - you’ll be working in Gmail /G Suite.
• A history of being organized and having high attention to detail - it’s the little things that matter.

Nice To Haves

• Prior experience in utilization management preferred.
• Things move swiftly at a startup - enjoying a fast paced environment is key.
• Love the details and organizational skills are a strong-suit.
• Understanding urgency and having the ability to juggle multiple priorities.
• You’re a problem solver by nature - schedules will change, things will come up, the printer will break, people will ask you for help.
• You can see the process and ways to make it better.
• Ability & agility to multitask - you may be asked to do several things and need to change plans mid day.
• Great communication skills - you’ll be talking and faxing with providers, partners, and members.
• You feel accountable for the work you’re responsible for.
• A calming presence - sometimes the days are ‘hair on fire’ and you’ll be the person people turn to for support.

Responsibilities

• Reviewing and determining prior authorization requests based on company policies and decision trees.
• Triaging/entering incoming prior authorization requests from provider offices.
• Applying preferred product strategies and working with providers to steer utilization of our part B medication benefit.
• Reaching out to hospitals and provider offices to obtain important clinical documentation.
• Contacting provider groups and members to ensure communication of clinical decisions.
• Addressing questions and concerns from members when alternative treatment options are needed.
• Providing operational support for key medical management processes enabling yourself, pharmacists, and physicians to make efficient, high-quality decisions.
• Acting as the main point of contact for both internal and external stakeholders in our workflows.
• Providing support for offshore clinical partners who assist us in workflows.
• Interpreting plan benefits and entering specialty pharmacy overrides for proper claim adjudication.

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed