[Hiring] Senior Pharmacy Technician @AffirmedRx, PBC

Role Description

The Senior Pharmacy Technician, Utilization Management leads the non-clinical administration of pharmacy utilization management (UM) programs by:

• Receiving, processing, and conducting non-clinical review of prior authorization requests.
• Obtaining required clinical and administrative information.
• Serving as a liaison among providers, pharmacies, members, and internal departments.
• Exercising discretion and independent judgment on non-clinical operational matters.
• Leading workflow coordination, training, and quality oversight.
• Resolving non-clinical escalations and serving as a super-user for UM technology.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, Pharmacy, Health Sciences, or a related field.
• 5+ years of pharmacy technician experience, including at least 3 years in UM, managed care, PBM, health plan, or comparable pharmacy benefit operations.
• Active pharmacy technician registration, licensure, or other credential required by the state(s).
• Current Certified Pharmacy Technician (CPhT) credential.
• Prior experience in a senior technician, trainer, quality reviewer, or workflow coordinator capacity.
• Experience supporting operational configuration, user acceptance testing, validation, implementation, or maintenance of prior authorization or UM technology platforms.
• Experience supporting pharmacy benefit configuration, formulary changes, clinical program implementation, audits, or process-improvement initiatives.
• Familiarity with NCQA, URAC, ERISA, state-specific, or other applicable utilization management and pharmacy benefit requirements.
• Demonstrated experience training, mentoring, coaching, or coordinating the work of others.
• Working knowledge of pharmacy prior authorization operations, pharmacy benefits, formulary management, exception processing, and appeals support.
• Experience using utilization management platforms, pharmacy claims systems, and Microsoft Office applications.
• Strong analytical, organizational, written and verbal communication, customer service, and problem-solving skills.
• Ability to exercise judgment and discretion to resolve ambiguous or non-standard operational situations.
• Demonstrated ability to exercise discretion and independent judgment in resolving operational matters of significance.
• Ability to manage multiple priorities, meet turnaround-time expectations, and maintain accuracy and attention to detail in a fast-paced environment.
• Ability to work independently and collaboratively across clinical, operational, and technical teams.
• Ability to maintain confidentiality and appropriately handle protected health information (PHI).
• Dedicated, private, and secure remote work environment that meets organizational requirements.
• Willingness to travel 10-20%.

Requirements

• Support appeals, reconsiderations, audits, quality initiatives, and regulatory or accreditation activities within the technician scope of responsibility.
• Protect confidential information and comply with HIPAA and all applicable federal, state, client, contractual, and organizational requirements.

Benefits

• To impact industry change in the pharmacy benefits management space, while delivering the highest quality patient outcomes.
• To work in a culture where people thrive because when OUR team thrives, OUR business thrives.
• Competitive compensation, including health, dental, vision and other benefits.