Pharmacy Technician, Utilization Management - Archimedes

Navitus Health Solutions, LLC•,

1d•Remote

About The Position

Archimedes is seeking a Pharmacy Technician, Utilization Management to join their team. This role supports the first-level review of specialty medication prior authorizations against clinical policies, high-cost case management functions, and internal clinical process development and maintenance activities. The Pharmacy Technician will manage an assigned work queue, supporting both clinical and non-clinical activities related to prior authorizations, benefit exclusions, formulary and therapeutic substitutions, and high-cost case management. The role involves communicating with physicians, nurses, pharmacists, and members to obtain outstanding documentation, support patient medication history collection, and provide drug cost information for specialty and traditional medications.

Requirements

High school diploma or GED required.
Licensed Pharmacy Technician required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

Pharmacy, Hospital, or Managed Care experience preferred.

Responsibilities

Develop and deliver follow up messages to physicians and members related to prior authorization and high-cost case management case documentation.
Manage and act as primary point of contact for all high-cost management and retroactive drug utilization cases, related to coordination of outbound physician notification and inbound case documentation.
Manage queues for pharmacy technician related work for prior authorization, high-cost cases, claims editing and clinical policy processes.
Perform prior authorization case management related to administrative denial and low-clinical acuity cases as identified by clinical policies and guidelines.
Participate in special projects, process improvement initiatives, and cross-functional assignments as needed to support departmental and organizational priorities.
Manage assigned ticket work by monitoring requests, researching issues, documenting actions, and ensuring appropriate and timely resolution or escalation.
Contact prescriber offices to request missing clinical information, supporting documentation, and other details needed to complete case reviews.
Complete timely follow-up with prescriber offices and document outreach attempts, responses, and received information accurately within applicable systems.
Other duties as assigned.