Clinical Pharmacy Technician II

Responsibilities

• Prior Authorization & Utilization Management: Reviews pharmacy utilization management (UM) coverage requests for both pharmacy and medical benefits and prepares such cases for clinical review when required. Applies plan-specific benefits appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines.
• Patient & Provider Coordination: Resolves non-clinical issues independently. Acts as a liaison between customers, provider-facing teams, and the Pharmacy Department. Engages in member and provider outreach to resolve issues such as appeal initiation requests, processing errors, and fulfilling notification requirements. Schedules appointments, verifies patient information, and addresses inquiries. Performs referral screening and processing, coordinating with specialists and ensuring timely patient access to necessary services.
• Data Management & Compliance: Responsible for all preauthorization entries into applicable databases (internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary. Conducts insurance evaluations to determine patient eligibility and coverage for services. Performs medication reconciliation tasks to ensure accurate medication lists and prevent potential drug interactions. Maintains regulatory compliance and resolves all cases within predetermined timeframes. Assists patients with applications to access affordable medications.

Qualifications

• 2 years of experience as a Pharmacy Technician, Patient Access Coordinator, or Medical Assistant in a healthcare setting
• Preferred: Associate degree
• Certified Pharmacy Technician (CPhT) from the Pharmacy Technician Certification Board
• None