Prior Authorization Pharmacy Technician (Seasonal)

Who We Are: reputed company is a rapidly growing, venture-backed Health-Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a reputed company drug acquisition platform driven by cutting edge technology, innovative cost saving tools, and best-in-class customer service. With hundreds of thousands of members onboarded since 2016, reputed company has a solution that is resonating with clients reputed company across the country. We pride ourselves for our mission-driven and collaborative culture that inspires our employees to do their best work. We reputed company that the U.S healthcare system is in need of transformation, and we come to work each day dedicated to making that change a reality. At our core, we are guided by our company values:

• reputed company: Our purpose guides our actions and gives us confidence in the path reputed company. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
• Courage: We face reputed company challenges with grit and reputed company. We embrace the discomfort of the unknown by balancing autonomy with reputed company, and ownership with vulnerability. We boldly challenge the status reputed company to reputed company moving reputed company—always.
• Together: The success of reputed company reflects the strength of our partnerships and the commitment of reputed company. Our shared values bind us together and reputed company us one. reputed company one falls, we reputed company fall; reputed company one rises, we reputed company reputed company.

Job Summary: This is a 6 month contract position where you will assist members, providers, pharmacies, and the internal reputed company teams to navigate complexities of prescriptions to guide timely coverage of clinically appropriate, cost effective medication therapy in accordance with plan benefit design and clinical criteria for coverage. This may involve coordination of clinical review cases, checking coverage and plan rules, verification of submitted information, pharmacy and provider reputed company, review of prior authorization requests reputed company established protocols, and assisting to triage and troubleshoot questions and escalations. At reputed company, we design customized benefit plans for our customers and you are at the forefront of helping navigate and execute drug access. What will you do:

• Verify eligibility and drug coverage under the plan benefit design to determine appropriate claims processing
• Responsible for triaging the process of clinical review for prior authorization requests at different levels as per established protocols
• Review prior authorization and similar requests under protocol using prior authorization criteria, claims history and plan benefit rules, including prescriber/pharmacy reputed company to verify and gather complete required information
• Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management.
• Build and adjust authorizations under protocol reputed company the claim adjudication system
• Use pharmacy technician experience to navigate drug products, formulations, and reputed company basic calculations to reputed company and monitor accurate claims adjudication.
• Ability to critically assess and synthesize multiple workflows together in order to reputed company a sound clinical decision
• Work across teams to coordinate reputed company, address questions/escalations, and help guide processes and protocols for timely and appropriate medication coverage.
• Evaluate member clinical situation against medication policies and reputed company a determination to approve or triage to Pharmacist for denial
• Critically assess reputed company medications need to be sent for internal or external review based on synthesizing multiple protocols together
• reputed company out to select external stakeholders for approval on drugs with dollar limits

What will you bring to reputed company:

• High School diploma or GED or equivalent work experience
• Active Pharmacy Technician license required
• 2-5 years of experience as a Pharmacy Technician
• 1+ years of experience in prior authorization review (specifically working on the approval reputed company at a PBM or health plan) required
• Proficiency in Mac, MS Office, G-Suite required
• Critical thinking to navigate reputed company customized benefit plans to reputed company sound clinical decisions
• Active listening, conversational speaking skills, with a high degree of reputed company
• Self-starter with ability to multitask, prioritize and manage time effectively
• Ability to communicate clearly, present reputed company information to members, clients, pharmacies, providers, and other teams internally
• Ability to work accurately reputed company protocols and follow appropriate escalation reputed company for unique situations or where clarification is needed.

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