Pharmacy Technician, Intermediate

About the Role

The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. In this role, you will resolve outpatient pharmacy benefit coverage inquiries, including prescription claim processing problems, and communicate drug formulary guidelines and alternatives.

Responsibilities

• Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit.
• Evaluate prior authorization requests based on medication policy and operational principles.
• Provide drug usage history and other pertinent pharmacy benefit-related inquiries to internal business partners to assist in case-specific reviews and drug evaluations.
• Communicate with physicians, physician’s office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries.
• Clearly communicate formulary alternatives and prior authorization criteria, and discuss pharmacy benefit coverage when required.

Requirements

• California Certified Pharmacy Technician license.
• 2 years of pharmacy-related experience and training; or equivalent combination of education and experience.
• Basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks.
• Ability to multi-task, set priorities, and manage time effectively.
• Strong phone and verbal communication skills along with active listening skills.

Schedule

• Requires the ability to work a flexible schedule and weekends as required.
• Hybrid virtual work: This role allows employees to work virtually full-time but may require office attendance based on business need.
• For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out-of-state employees, and those in certain member-facing roles should work with their manager to determine in-office time based on business need.

Pay

• Pay Range for California: $21.73 to $30.43 per hour.
• Pay Range for Bay Area: $24.50 to $34.31 per hour.

Salaries are based on candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendium. Ascendium is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendium Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming healthcare in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

Blue Shield is recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also recognized by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the United States.

Our Values

• Honest: We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human: We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous: We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Physical Requirements

• Office Environment: Roles involving part- to full-time schedule in an office environment.
• Based in our physical offices and work from home/desk work.
• Activity level: Sedentary, frequency most of the workday.