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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleClinical Operations TechnicianJob DescriptionThe Associate Clinical Operations Technician is responsible for processing, communicating, documenting and tracking requests for formulary exceptions, prior authorizations, quantity exceptions, and brand override for delegated utilization management (UM) products and services.Responsibilities
Review criteria to determine if the request can be approved and accurately enter Prior Authorizations in claims system to ensure appropriate claims will adjudicate
Respond to completed requests by creating written communication of the clinical outcome to the member and the member’s physician within client specific turnaround times
Research and respond to calls and emails
Perform outreach calls to pharmacies and physician’s offices related to the department process across multiple clients to obtain all necessary information related to UM requests, including occasional member assistance
Provide all relevant clinical information specific to a UM request to a department Pharmacist and the Physician
Manage work queue and volumes to meet client specific turnaround times
Commercial: Responsible to be proficient in one area (i.e., intake, research, etc.); area assignment is based on department need
Government Programs: Responsible to be proficient in single review, approval/denial, etc.
Other duties as assigned
Minimum Qualifications
High school diploma from an accredited school or equivalent GED
Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
Availability to work overtime, weekends and holidays on a rotating basis as needed
Ability to work a flexible schedule to accommodate business needs
Strong verbal and written communication skills, interpersonal skills, and attention to detail
Demonstrated organizational and time-management skills
Willingness and ability to learn internal systems/processes/programs as needed
Basic math skills and general PC knowledge including Microsoft Office, Internet, and email
Preferred Qualifications
Associate’s degree in business or related area of study, or equivalent combination of education and/or relevant work experience
National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)
PBM/health care experience
Minimum Physical Job Requirements
Constantly required to sit, use hands to handle or feel, talk and hear
Frequently required to reach with hands and arms
Occasionally required to stand, walk and stoop, kneel, and crouch
Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
Reports to Supervisor in the Clinical Review department
Potential pay for this position ranges from $18.85 - $24.42 based on experience and skills. Pay range may vary by 8% depending on applicant location.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
