Pharmacy Technician, Retrospective Case Management

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🔥 0 minutes ago

🏈 Alabama, Colorado, +17 more states – Remote

🏈 Alabama – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 10%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Manage assigned work queues related to non-clinical retrospective case management operations, benefit exclusions, formulary and therapeutic substitutions, and high-cost case management • Communicate with physicians, nurses, and pharmacists regarding outstanding case documentation, patient medication histories, and specialty/traditional medication cost information • Perform first reviews of retrospective case management for specialty medications against policies • Support high-cost case management functions • Participate in internal clinical process development and maintenance activities • Help develop expanded services that can be performed by pharmacy technicians • Develop and deliver follow-up messages to physicians regarding case management documentation • Organize peer-to-peer collaboration between physicians and pharmacists • Serve as primary point of contact for high-cost case management and retroactive drug utilization cases • Coordinate outbound physician notifications and inbound case documentation • Manage queues and organize documents for pharmacy technician case management work • Perform retrospective case management for provider denial and low-clinical-acuity cases identified by clinical policies and guidelines • Participate in, adhere to, and support compliance, people and culture, and learning programs • Perform other duties as assigned

🎯 Requirements

• High school diploma or GED required • Licensed Pharmacy Technician required • Pharmacy, Hospital, or Managed Care experience preferred • Benefit knowledge and experience preferred • Proficient in Microsoft Excel, Power Point, and Word required • Ability to participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees • Remote work is available only to residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, or Wisconsin • M-F: 8:00 am – 5:00 pm

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750! • Fully remote work arrangement