GREAT PAY AND BENEFITS! AMAZING WORK LOCATION! NOT A REMOTE POSITION. Position Purpose:As a Certified Pharmacy Technician (CPT), the employee will be responsible for answering incoming calls from Providers and initiating any necessary outbound calls to members and Providers. The CPT will also be responsible for reviewing requests from members, prescribers and pharmacies to determine whether medication coverage can be authorized based on benefit plan design, client specifics and clinical criteria. The CPT will need to work simultaneously within multiple computer systems, responding to questions and/or providing specific medication details / clinical information in a timely manner. The CPT reports to the Pharmacy Director and Part D Manager. Key Responsibilities:
Provide support in obtaining supporting statements and clinical information necessary for coverage determinations
Explain the Plan’s formulary, formulary structure and different benefit stages
Enter and maintain accurate prior authorization records
Answer provider calls as this is a provider call center for pharmacy inquiries and effectively communicate processes and benefits
Consult with pharmacists and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
Respond to inquiries from other departments, physicians and members related to formulary and prescription benefits
Participate in various Pharmacy-related projects, including assisting with Medication Adherence and Medication Therapy Management outreach to members.
Review Paid and Rejected Claims to ensure the pharmacy benefit is implemented properly.
Work as a Liaison between the Pharmacy department and the Pharmacy Benefit Manager (PBM)
Work as a Liaison between the Pharmacy department and the Utilization Management Department (i.e. Medical Management Department) to ensure proper workflow between Part D requests and Part B requests and to prevent the simultaneous coverage of a medication under BOTH benefits.
Assist the Utilization Management Department with Part B drug requests (e.g. Cost review, entering Part B authorizations/overrides, where applicable)
Work schedule between the hours of 8AM and 6PM, Monday through Friday [shifts available include: 8AM – 5PM and 9AM – 6PM (with one hour of lunch)]. Will work remotely on weekends and holidays (alternating with other CPhTs) on an “on-call” basis.
Qualifications:
State of Florida Certified Pharmacy Technician License (CPhT) required
Managed Care Pharmacy experience desired
Retail Pharmacy experience preferred
Bilingual (English/Spanish) required
Knowledge of pharmaceutical generic and brand names
Strong Microsoft software and computer skills (Word, Excel, Powerpoint, Access, Outlook)
Efficiency in a fast-pacedenvironment
Team player
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWPOpportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein. Powered by JazzHR
