Pharmacy Technician - Medication Management, Prior Authorization

Cleveland Clinic

1d•Remote

About The Position

The Pharmacy Technician in Medication Management and Prior Authorization supports medication access in a work-from-home role. The position processes prescription claims, conducts initial benefits investigations, assists with copay assistance programs, completes prior authorization chart reviews to identify medication changes, processes prescriptions in computer systems, and manages incoming phone calls while balancing daily tasks. Training is tailored to the caregiver’s skills and experience, with opportunities for professional growth within Pharmacy and Cleveland Clinic. Applicants must reside in Ohio or Florida. The role includes in-person training and a monthly on-site meeting. Ohio-based meetings take place at the Beachwood administrative campus; Florida meetings take place at the Florida Research and Innovation Center in Port St. Lucie. The position works eight-hour shifts, Monday through Friday, between 7:30 a.m.–4:00 p.m. and 8:00 a.m.–4:30 p.m. Weekends and holidays are not required.

Requirements

High school diploma or GED.
Upon hire, certification as a Certified Pharmacy Technician (CPhT) through the Pharmacy Technician Certification Board (PTCB) or the National HealthCareer Association (NHA).
Upon hire, active registration through the Ohio Board of Pharmacy as a Certified Pharmacy Technician, Registered Pharmacy Technician, or Pharmacy Technician Trainee.
Caregivers with active Pharmacy Technician Trainee or Registered Pharmacy Technician registrations must update to Certified Pharmacy Technician registration with the Ohio Board of Pharmacy within six months.
Must reside in Ohio or Florida.
Ability to perform the job while standing, reaching, stretching, stooping, and sitting for prolonged periods.
Manual dexterity sufficient to perform computer and dispensing functions.
Ability to lift up to 20 pounds while walking, stooping, bending, and reaching.
Follow standard precautions and use personal protective equipment as required.

Nice To Haves

Completion of a formal pharmacy technician training program.
One year of experience in a pharmacy technician role.

Responsibilities

Initiate prior authorizations and communicate with third-party payers on behalf of physicians and patients.
Find and apply manufacturer copay cards and initiate patient assistance and copay assistance applications.
Contact patients to manage refills and schedule necessary current and future assessments.
Verify patient, drug, quantity, directions, days’ supply, insurance, and physician information to ensure accuracy of prescription and patient data entered in various systems.
Conduct benefits investigations and process necessary prior authorizations and/or appeals for pharmacy claims.
Explain benefit coverage and financial responsibilities to patients.
Provide financial assistance contact information and/or initiate patient assistance and copay assistance applications on behalf of patients.
Resolve specialty pharmacy insurance matters, including Medicare, Medicaid, Pharmacy Benefit Managers (PBMs), and Preferred Provider Organizations (PPOs), and communicate results to payers, patients, or physicians as needed.
Use pharmacy systems to review patient profiles, enter changes, and establish assessment schedules.
Document patient, client, and provider contacts in appropriate computer systems.