Pharmacy Technician

Job Title: Pharmacy Technician

Location: REMOTE candidate needs to reside in the tri-state (PA, DE, or NJ) area

Contract: 03+ months with possible contract extension

Shift: Monday to Friday Business hours

Hours Per week: 40 hours per week.

Description:

Job Summary:

The Pharmacy Technician’s primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. If necessary, the Pharmacy Technician directly interacts with providers to obtain additional clinical information. The Pharmacy Technician has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the Pharmacy Technician provides relevant information regarding members medical condition to the Clinical Care Coordinator for their further review and evaluation. The Pharmacy Technician is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations.

Key Responsibilities:

Applies critical thinking and judgement skills based on advanced medical knowledge to cases utilizing specified resources and guidelines to make case determination.
Utilizes resources such as Care Management Policy, Medical Policy, MicroMedex and Electronic Desk References to determine the medical appropriateness of the proposed plan.
Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
Notifies ordering providers and Specialty Pharmacy Vendor or approved authorization to arrange shipment of medications to the office.
Reviews treatment plans/plan of care with provider for requested medications, clarifying medical information with provider if needed.
Identifies and refers cases where medical necessity criteria are not established to the Clinical Care Coordinator for further evaluation determination.
Ensures request is covered within the member’s benefit plan.
Ensures utilization decisions are compliant with state, federal and accreditation regulations.
Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
Ensures that all key functions are documented via Care Management and Coordination Policy.
Maintains the integrity of the system information by timely, accurate data entry.

Requirements: