Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns. Years of experience required: Minimum 3 years of Pharmacy Technician experience (open to PBM, retail, or other various experience).
Numbers & Facts
Location
Various, CA (Remote)
Salary
$24 Per Hour
Description
Summary:
Location: 100% Remote - National
Duration: 6 months, possible extension
Shift: Monday – Friday (8 AM to 4:30 PM). No overtime, flexible start/end time.
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.
Assist Provider Relations and various departments with educating providers on the health plan’s 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.
Perform other duties as assigned.
Comply with all policies and standards.
Requirements:
Required Education: High school diploma.
Years of experience required: Minimum 3 years of Pharmacy Technician experience (open to PBM, retail, or other various experience).
Disqualifiers: No Pharmacy experience.
Preferred Skills:
Prefer a Pharmacy Technician License but not required.
Experience with Microsoft Office – Excel, Word, Outlook, Visio.
Ability to work independently and maintain good communication about project/assignment updates.
Ability to multitask and properly prioritize work.
Experience with projects or assignments that require attention to detail.