Utilization Management Support Technician

About the role

The organization operates in the pharmacy benefit management (PBM) sector, focusing on managing pharmacy spend to make medications more affordable for employees and their dependents. It offers a PBM model based on principles of fairness, transparency, unlocking the supply chain, supporting physician-patient relationships, and empowering consumers through navigation. The company aims to address challenges in pharmacy benefits to enhance healthcare sustainability and cost management for clients.

The Utilization Management Support Technician role is part of the Utilization Management team within the organization's pharmacy operations. This position supports the delivery of utilization management strategies by processing authorization requests, coordinating communications among members, providers, and internal teams, and ensuring compliance with regulatory guidelines. The role contributes to efficient management of pharmacy benefits and supports patient access to necessary medications.

Responsibilities

• Facilitate the utilization management request process across all business lines.
• Enter authorizations into the claims platform.
• Communicate with members and providers regarding utilization management cases.
• Support specialty management program members, including coordinating prior authorizations and patient assistance.
• Collaborate with pharmacy technicians, pharmacists, and medical directors on utilization management activities.
• Contact provider offices to obtain missing clinical information for cases.
• Ensure case reviews comply with State and Federal guidelines and turnaround times.
• Participate in quality review and inter-rater reliability processes.
• Respond to prescriber inquiries about the status of utilization management requests.
• Maintain regulatory and privacy standards consistently.

Requirements

• 1-2 years experience as a pharmacy technician in a PBM, pharmacy department of a health plan, managed care setting, mail order, or specialty pharmacy.
• Active National Certified Pharmacy Technician (CPhT) certification.
• Detail-oriented with critical thinking and empathy.
• Knowledge of pharmacy claims adjudication, benefit designs, and call center experience.
• Ability to multitask, prioritize, and work independently.
• Associate's or Bachelor's degree preferred.

Pay

$22.00 per hour. Compensation will be determined by geographic location, experience, and qualifications.