[Hiring] Clinical Pharmacy Technician @MRIoA

Role Description

Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.

• Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication.
• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.

Roles

• Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines.
• Accountable for achieving prior authorization processing productivity and accuracy standards.

Major Responsibilities or Assigned Duties

• Enter prior authorizations into the system and prioritize requests.
• Check formulary alternatives and review tried and failed medications.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition.
• Document all related information regarding the PA approval or non-approval.
• Conform to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making.
• Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Analyze, research, and resolve prior authorization processing issues, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies.
• Obtain input from supervisor or clinical pharmacists; refer unique or high dollar requests to supervisor according to guidelines.
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Document prior authorization-related information and status.
• Make outbound calls to obtain information and answer questions about prior authorization status.
• Protect and maintain confidentiality and privacy of all prior authorization and member information.
• Identify and recommend operational improvements.
• Participate in and support all applicable Quality Management initiatives.
• Maintain a flexible schedule to meet client needs, as needed.
• Adhere to all policies and procedures.
• Take feedback and responsibility for performance.
• Adapt to the differences of clients.
• Support all Compliance Program activities.
• Complete other duties and responsibilities as directed.

Position Levels

• Clinical Pharmacy Technician I:
  • Production should increase regularly, from 1-3 to 7 Prod steps/hour.
  • Quality should increase regularly, with expected minimum rate of 95%.
• Clinical Pharmacy Technician II:
  • 3-month Production average should meet or exceed 7 Prod steps/hour (100%).
  • 3-month Quality average should meet or exceed 96%.
  • No PIPs or CAPs in prior 3 months for any reason.
  • Completed all training checklists for department and demonstrated proficiency with position processes and PG clients.
  • Participate in the weekend rotation process.
  • Proficient with all position processes and team clients’ expectations.
  • Demonstrate ability to create training documents/presentations.
• Clinical Pharmacy Technician III:
  • 3-month Production average should meet or exceed 8.3 Prod steps/hour (118%).
  • 6-month Quality average should meet or exceed 98%.
  • No PIPs or CAPs in prior 6 months for any reason.
  • Effectively manage PANF reports, daily assignments, LOI, and Outreach calls.
  • Demonstrate problem solving and ability to work cross-functionally for new projects and HQs.
  • Demonstrate ability to train other PACs on HQ/processes and provide constructive feedback.
  • Effectively assist with monthly audits when asked.
  • Correctly approve PAC I-II Overdollar requests, as well as own.
  • Participate in special projects, lead committees, or pilot new processes/improvements.
• Clinical Pharmacy Technician IV:
  • 3-month Production average should meet or exceed 9.7 Prod steps/hour (138%).
  • Effectively regularly assist with monthly audits and calibration calls.
  • Cross trained on RxAdvance process/system and capable of filling in at any time.
  • Participate in the weekend rotation and weekend leadership on-call process.
  • Effectively train and mentor new hires from day 1 overview to end of 120 days, including weekly training meetings.
  • Participate in the Customer Advocate Program.
  • Effectively cover the floor without a supervisor, including for escalated calls or emails.

Qualifications

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice.
• Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc.
• Strong organizational skills with attention to detail.
• Strong oral and written communication skills.
• Excellent critical thinking capabilities with a strong attention to detail.
• Exceptional customer service skills.
• Minimum one-year prior authorization experience preferred.
• Health plan or Pharmacy Benefit Manager experience preferred.

Requirements

• High school diploma or equivalent.
• Active Certified Pharmacy Technician (State or National License).

Benefits

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.