Join Our Team as a Remote Initial Review Pharmacy Technician
Are you a motivated and detail-oriented pharmacy professional looking for a new challenge? Do you have a passion for clinical review and utilization management? We're seeking an experienced Initial Review Pharmacy Technician to join our team remotely! As a key member of our medical and pharmacy management initiatives, you'll play a crucial role in driving success and achieving our revenue goals and operational objectives.
About Prime Therapeutics
At Prime Therapeutics, we're dedicated to improving the quality of healthcare and patient outcomes through innovative pharmacy solutions. Our team of experts works closely with health plan and payor customers to develop and implement effective utilization management programs. We're committed to fostering a dynamic and inclusive work environment that encourages growth, learning, and collaboration.
Job Summary
As an Initial Review Pharmacy Technician, you'll be responsible for executing utilization management programs on behalf of our health plan and payor customers. You'll utilize your clinical knowledge and expertise to review prospective and retrospective requests for therapeutic appropriateness, making approval recommendations based on sound clinical criteria. This is a unique opportunity to work in a fast-paced, remote environment and contribute to the success of our organization.
Key Responsibilities
- Clinical Review: Review pertinent patient information and assess appropriateness using clinical criteria, making approval recommendations for all services that meet these criteria.
- Communication: Contact physicians, prescribers, patients, and pharmacies to gather additional clinical information necessary for determining medication reimbursement.
- Utilization Management: Practice and maintain the principles of utilization management by adhering to company policies and procedures, ensuring the clinical integrity of pharmaceutical solutions through ongoing training programs.
- Program Integrity Audits: Conduct Program Integrity Audits, including outreach and review of medical records to verify the authenticity of provider responses during Prior Authorization.
- Documentation: Assist with documentation and implementation of written and verbal communications to physicians and prescribers.
- Data Management: Maintain edits and data elements that support these edits.
- Consultation: Provide consultation on pharmacy-related questions to resolve claims submission issues related to medication edits.
- Customer Service: Provide optimum customer service through professional and accurate communication while adhering to NCQA and health plan-required timeframes.
- Escalation: Escalate medical exception requests to a nurse, pharmacist, or physician on the utilization review clinical team when further review is necessary.
Requirements
Education and Experience
- Licensure/Registration: Must have an active pharmacy technician licensure or registration in accordance with state requirements.
- Certification: If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration and an active national certification (e.g., PTCB or ExCPT).
- Experience: Minimum of 2 years of pharmacy experience without a Bachelor's degree OR 2 years of pharmacy experience with a Bachelor's degree in Science, Health, Medical or related field.
- Specialty Experience: Specialty or retail pharmacy experience, previous reimbursement experience, and/or working in a health plan/health care setting.
Skills and Competencies
- Analytic Skills: Ability to translate complex clinical information into practical recommendations.
- Communication Skills: Excellent verbal and written communications skills.
- Computer Skills: Basic skills with Microsoft office products and ability to quickly learn proprietary systems.
- Team Orientation: Strong team orientation with respect for all members.
- Clinical Knowledge: In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, and medical terminology.
Nice-to-Haves
- Oncology Pharmacy Experience: Experience working in oncology pharmacy or other clinical pharmacy settings.
- Additional Experience: 4 years of pharmacy experience.
What We Offer
Compensation and Benefits
- Competitive Pay: Salary ranging from $22.84 - $34.25 based on experience and skills.
- Comprehensive Health Insurance: Coverage for you and your family.
- 401k Retirement Savings Plan: With company matching contributions.
- Paid Time Off: And holidays.
- For further education.
- Professional Development: Opportunities for growth and learning.
- Employee Discounts: On various services and products.
Work Environment and Culture
- Remote Work: Enjoy the flexibility of working from home.
- Dynamic Team: Collaborative and inclusive work environment.
- Professional Growth: Opportunities for career advancement and skill development.
Take the Next Step
Are you ready to join our team as an Initial Review Pharmacy Technician? Apply now and let's discuss how you can become a vital part of our success story.
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Apply Now
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