FULL TIME:  8:00am-4:30pm CONTRACT: 3 months  START:  11.11.19

JOB SUMMARY: Under the direction of the Supervisor, Pharmacy Utilization Management, the Pharmacy Utilization Management (UM) Technician is responsible for setting up cases in the various applications for drug prior authorization (PA) requests and performs daily quality checks to ensure compliance.  The technician will run test claims once authorization are approved and reach out to members and providers as necessary. Works with automated prior authorization (auto PA) tools to:

• Completes data entry (case setup) from faxes (RightFax system) or phone calls.
• Performs member eligibility check.
• Checks for duplicates and determine if more information is needed.
• Reviews case per established protocol to either approve or deny case.
• Sends unable to authorized requests to pharmacist review queue.
• Reviews items in the manual queue and resolves or forwards accordingly.
• Performs daily quality checks (QC) of approvals on a rotating basis.
• Monitors intake and technician queue to ensure all requests are completed within established timeframes.
• Enter authorization records (PA) allowing health plan restricted drug to be processed.

Performs and processes test claims to ensure all adjudications are successful. Follows policies and procedures and workflows in processing pharmacy prior authorization requests, consistent with department policies and procedures, applicable regulatory and accreditation requirements and turnaround times. Performs other duties and projects as assigned by the Pharmacy Utilization Management Team. EDUCATION: (Minimum education & certifications required)

• High School Diploma or GED
• Associate's degree in Healthcare, Nursing, or a related area or equivalent experience.
• Certified Pharmacy Technician (CPhT)

  EXPERIENCE: (Years of experience)

• Minimum of 3+ years of pharmacy experience, preferably in managed care setting or PBM.
• Software/Database experience-MedHOK, RxClaim, CCMS and CAS or other database/software experience is preferred
• Proficient in MS Office-Excel, Word, and PowerPoint preferred

  SKILL REQUIREMENTS: (Include interpersonal skills)

• Ability to prioritize work when processing pharmacy PA requests per guidelines and within specific turnaround timeframes.
• Ability to process high volumes of requests with great accuracy.

·      Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment. ·  Good working knowledge of medical terminology. ·   Must be able to work independently, and as part of a team.   Regular interface with various levels of staff and management is required as well. ·  Must be able to exercise appropriate judgment as necessary.   WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime) ·   Fast paced office environment handling multiple demands.  Open cubicle work setting with a personal computer.

• Travel required on an as needed basis.  Some early mornings, evenings, weekends, or extended work day may be required or as program dictates.  Must have flexibility with work schedule.