Temporary Pharmacy Technician
About The Position
Western Health Advantage (WHA) is seeking a temporary Pharmacy Technician to support pharmacy utilization management activities at the health plan level. The technician works closely with the Chief Pharmacy Officer, Pharmacy Manager, Medical Directors, Clinical Pharmacists, and Pharmacy Coordinator to ensure prescription medication requests are reviewed accurately, efficiently, and in accordance with regulatory requirements. The position reviews authorization requests using established protocols, coordinates member and provider notifications, assists with interpreting pharmacy benefits, and supports pharmacy-related appeals and grievances. The role also contributes to maintaining formularies and authorization criteria, audit activities, pharmacy policies and training materials, and timely case coverage.
Requirements
- High school diploma or equivalent.
- At least three years of experience as a Pharmacy Technician.
- At least two years of experience in a utilization management or managed care environment.
- A valid California Pharmacy Technician License in good standing, maintained throughout employment.
- Intermediate computer skills, including email, database systems, word processing, and spreadsheets.
- Strong attention to detail, organization, research, and problem-solving skills.
- Ability to communicate clearly and professionally with members, providers, Medical Groups, and internal departments.
- Ability to speak, read, write, and understand the primary language used in the workplace.
Nice To Haves
- Customer service or call center experience is highly desired.
- Experience preparing professional business correspondence.
Responsibilities
- Review prescription medication authorization requests using established protocols and criteria.
- Refer clinical questions or requests outside standardized criteria to a Clinical Pharmacist for review.
- Coordinate with the Pharmacy Coordinator and internal departments to ensure authorization decisions and notifications are accurate and completed within regulatory timeframes.
- Prepare and send approval, authorization, and denial letters to members and providers.
- Research and prepare pharmacy cases for review by Pharmacy leadership, Clinical Pharmacists, or the Chief Medical Officer.
- Assist Member Services Representatives and Medical Group staff with interpreting pharmacy benefits and prior authorization criteria.
- Support research and resolution of pharmacy-related appeals and grievances.
- Help maintain the WHA Formulary Drug List and Pharmacy Prior Authorization criteria based on Pharmacy and Therapeutics Committee decisions.
- Assist with pharmacy and Pharmacy Benefit Manager audits, including DMHC and NCQA accreditation reviews.
- Maintain current knowledge of medications, drug classifications, pharmacy benefits, and authorization requirements.
- Support administrative functions, including provider and member notifications and returned-mail processing.
- Assist with developing and maintaining pharmacy policies, training materials, and desktop procedures.
- Provide mentoring and training to less-experienced Pharmacy Technicians and Pharmacy Coordinators, as needed.
- Help provide coverage during holidays and Friday evenings to complete cases within required regulatory timeframes.
- Perform additional duties and special projects as assigned.
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What This Job Offers
Career Level
Mid Level
Education Level
High school or GED
