Location: 100% Remote - National
Shift: Monday Friday (8 AM to 4:30 PM).. No overtime and we can be flexible on the start/end time.
Duration: 6+ months, possible extension
Purpose of this job: T he teams purpose is responsible for building and maintaining decision tools, also known as questionnaires. These tools support pharmacy operations, specifically around prior authorization processes. We develop and manage configurable questionnaires that align with health plan and drug policies which help the prior authorization reviewers make their determination.
Description: Job Profile Summary
Responsibilities
Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team.
| Candidate Requirements |
| Education/Certification | Required: high school diploma | Preferred: |
| Licensure | Required: | Preferred: prefer a Pharmacy Technician License but not required. |
Years of experience required: 3+ years of Pharmacy Technician experience (open to PBM, retail, or other various experience)
Disqualifiers: No Pharmacy experience
Additional qualities to look for: Ability to multitask or properly prioritize work, Experience with projects or assignments that require attention to details. |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Pharmacy Technician experience (open to PBM, retail, or other various experience) |
| 2 | Microsoft Office Experience Excel, Word, Outlook, Visio |
| 3 | Ability to work independent and keep good communication with about their project/assignment updates. |
Assist Provider Relations and various departments with educating providers on the health plans pharmacy process
Assist with the pharmacy utilization review and reporting process
Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
Assist with members inquiries related to the formulary process
Performs other duties as assigned
Complies with all policies and standards