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Capital Rx

Affordable Pharmacy Benefits, Powered by Modern Infrastructure.

Utilization Management Technician – Temp-to-Hire

GeneralGeneralFull TimeRemoteMid LevelTeam 501-1,000Since 2017H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

0

Seniority

Mid Level

High School2 yrs expEnglish

Job Description

Utilization Management Technician – Temp-to-Hire

Capital Rx

• Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines • Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review • Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. • Review and analyze pharmacy claims data for proactive outreach and intervention. • Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. • Effectively communicate issues and resolutions to members, pharmacy staff, providers, and appropriate internal stakeholders. • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies • Ensure customer satisfaction, extraordinary customer care, and quality resolution with genuine compassion in a fast paced, startup environment

Job Requirements

  • 2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
  • Experience handling prior authorization requests/understanding of prior authorization requirements required
  • National Certified Pharmacy Technician (CPhT) license, required
  • High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred
  • Excellent communication, writing, and organizational skills
  • Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
  • Ability to multi-task and collaborate in a team with shifting priorities

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements

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