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Clinical Pharmacy Technician I-Wexford-Hybrid Position

1 month ago

Wexford, Pennsylvania, United States Highmark Health Full time

Job Summary:

This position supports the network centralized prior authorization department at Highmark Health. The Clinical Pharmacy Technician I-Wexford-Hybrid is responsible for coordinating and administering the effective and efficient processing of the pharmacy benefits prior authorization process.

Key Responsibilities:

  • Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required.
  • Applies plan-specific benefits to each case, summarizes pertinent facts, and cites applicable internal policies and guidelines.
  • Resolves non-clinical issues independently and acts as a liaison between customer and provider-facing teams and the Corporate Pharmacy Department.
  • Maintains regulatory compliance and resolves all cases within predetermined timeframes.
  • Responsible for all preauthorization entries into applicable databases to ensure swift and appropriate payment of services deemed medically necessary.
  • Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements.

Requirements:

  • 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting.

Preferred Qualifications:

  • None

Skills:

  • Strong knowledge of medical and pharmaceutical terminology.
  • Strong verbal and written communication skills.
  • Well organized, paying close attention to detail.
  • Ability to identify and resolve problems.
  • Ability to handle multiple priorities in a timely manner.
  • Strong interpersonal skills.
  • Ability to work independently or in a team environment.
  • Customer oriented.
  • Proficient with Microsoft Office products.

Education:

  • Associate degree.

Licenses or Certifications:

  • Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board.

Language: English

Travel Requirement: 0% - 25%