Senior Pharmacy Technician, Utilization Management

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

💊 Pharmacist

👻 Ghost score 12%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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AffirmedRx, a Public Benefit Corporation

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

AffirmedRx is a Public Benefit Corporation dedicated to transforming the pharmacy benefit management (PBM) industry. Focused on transparency, patient-centric care, and innovative solutions, AffirmedRx aims to overcome the complexities and opacity that traditionally plague the PBM sector. By empowering individuals and organizations, the company provides clarity and unwavering support in navigating pharmacy benefits. AffirmedRx stands for integrity and partnership, striving to offer a healthier and more informed pharmacy benefits experience while boldly tackling the rising costs of healthcare and pharmaceuticals.

📋 Description

• Receive, process, and conduct non-clinical review of pharmacy prior authorization requests and supporting documentation • Verify member eligibility, benefit coverage, authorization requirements, and administrative information • Maintain authorization records in utilization management, pharmacy claims, and related systems • Obtain and document information from providers, pharmacies, members, and other healthcare entities • Assess submissions for completeness, route cases appropriately, and escalate non-standard cases to pharmacists • Prepare cases for pharmacist review and communicate authorization status or additional-information requests • Monitor work queues and prioritize requests to meet turnaround-time and notification requirements • Support appeals, reconsiderations, audits, quality initiatives, regulatory activities, and accreditation efforts • Serve as a subject matter expert for UM technicians and coordinate workload distribution and queue prioritization • Monitor operational performance indicators, analyze barriers, implement corrective actions, and report outcomes to UM leadership • Conduct quality reviews, coach and train technicians, and support onboarding and mentoring • Develop and maintain workflows, standard operating procedures, job aids, and training materials • Serve as super-user for prior authorization and UM technology platforms • Lead configuration, testing, validation, implementation, maintenance, formulary updates, UM programs, and system enhancements • Collaborate with pharmacy, clinical, operations, claims, and technology teams to resolve workflow and system issues • Identify and implement process improvements and support compliance initiatives

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field • 5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations • Active pharmacy technician registration, licensure, or other credential required by the state(s) in which the employee performs services • Current Certified Pharmacy Technician (CPhT) credential • Prior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity • Experience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms • Experience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives • Familiarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements • Experience training, mentoring, coaching, or coordinating the work of others • Working knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support • Experience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications • Strong analytical, organizational, written and verbal communication, customer service, and problem-solving skills • Ability to exercise judgment and discretion in non-standard operational situations and escalate matters requiring pharmacist review • Ability to manage multiple priorities, meet turnaround-time expectations, and maintain accuracy in a fast-paced environment • Ability to work independently and collaboratively across clinical, operational, and technical teams • Ability to maintain confidentiality and handle protected health information (PHI) • Dedicated, private, and secure remote work environment meeting organizational requirements • Willingness to travel 10–20%

🏖️ Benefits

• Competitive compensation, including health, dental, vision and other benefits • Opportunity to impact industry change in the pharmacy benefits management space while delivering high-quality patient outcomes • Culture where people thrive • Remote work arrangement

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