Senior Clinical Pharmacy Technician – MCO Clinical Liaison

🔥 1 minute ago

🗽 New York – Remote

🗽 New York – Remote

💵 $19 - $28 / hour

⏰ Full Time

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Evaluate and process prior authorization requests, determining medication appropriateness, applying clinical criteria, and communicating decisions • Research, resolve, and document prior authorization outcomes and complex provider/member inquiries • Lead complex care coordination for New York Medicaid members, including provider outreach, claim resolution, coverage clarification, and prior authorization facilitation • Educate providers on formulary coverage, NYRx program requirements, prior authorization processes, and therapeutic alternatives • Escalate cases requiring additional clinical review or denial to a pharmacist • Deliver high-quality customer service while meeting performance, accuracy, and service-level expectations • Perform the essential functions of the role and other assigned duties

🎯 Requirements

• High school diploma from an accredited school or equivalent GED • 2 years of work experience as a pharmacy technician • Required CPT/ExCPT/LPT/PT/RPT Pharmacy Technician certification/state requirements • Must be eligible to work in the United States without work visa or residency sponsorship • Strong knowledge of specialty injectable prescription drugs, disease states, formulary management techniques, medical terminology, and reimbursement coding practices • Proficiency in pharmacy systems, software applications, and Microsoft Office products • Excellent written and verbal communication skills • Ability to interpret and apply established clinical criteria and operational procedures • Ability to identify, troubleshoot, and resolve operational issues • Every employee must comply with applicable legal, regulatory, contractual, security, and internal policy requirements

🏖️ Benefits

• Benefits, incentives, and additional compensation are available; see the Benefits Page • Equal opportunity and affirmative action employer • Reasonable accommodations for employees with disabilities • Tobacco-free workplace