Clinical Manager, Prior Authorization Technician

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Capital Rx

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Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx is the fastest growing healthtech company in America, dedicated to transforming the prescription pricing and patient care landscape. Founded in 2017, it offers innovative pharmacy benefit management (PBM) services, including customizable pharmacy benefits for large employers and an AI-powered care navigation platform. Capital Rx focuses on delivering cost-effective solutions and operational efficiencies to clients while ensuring transparency and quality care for patients.

501 - 1000 employees

Founded 2017

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

📋 Description

• Oversee a dynamic team of pharmacy technicians engaged in the prior authorization process. • Analyze available data to provide prior authorization staffing, workflow, and system enhancement recommendations to maximize team agility and performance. • Actively participate in the prior authorization technician metric and quality goal setting process. • Generate and deliver comprehensive reports on prior authorization technician metrics to both internal and external stakeholders. • Assist the talent acquisition team in the hiring, evaluation, training, and onboarding of new employees. • Investigate/resolve escalated issues or problems from team members, clients, and other internal teams. • Key stakeholder in ensuring the prior authorization review platform is optimized for technician functions. • Maintain relationships with external Independent Review Organizations and clinical resource vendors. • Support the training and growth of both new and existing staff members in adherence to proper procedures. • Collaborate with prior authorization leadership to develop process improvements and support long-term business needs, recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and help establish best practices for conflict resolution while actively participating in problem identification and coordinate resolutions between appropriate parties. • Assist with in other responsibilities, projects, implementations, and initiatives as needed in accordance with the policies and procedures established within the department. • Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines. • Maintain compliance with local, state, and federal laws, in addition to established organizational standards. • Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review. • Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions. • Follow all internal Standard Operating Procedures and adhere to HIPAA guidelines and Company policies

🎯 Requirements

• Active, unrestricted, National Certified Pharmacy Technician (CPhT) license required • Bachelor’s or Associate’s degree is preferred • 4+ years of PBM or Managed Care pharmacy experience required • Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint • Strong clinical background required • Excellent communication, writing, and organizational skills • Ability to multi-task and collaborate in a team with shifting priorities

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off