Remote Pharmacy Technician- Call Center

• High volume inbound call center serving calls from Member, Pharmacy and Prescribers.
• Measurements include quality, average handle time, productivity metrics, schedule adherence, and behavioral competencies.
• Candidate MUST be available to work a set schedule during training and MUST be available and commit to work any assigned shift between the hours of 8:00am and 10:00pm EST daily including weekends and holidays.

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• Performs other duties as required.
• For CPTs assigned to work the fax queue, responsibilities will also include:

• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.

• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).

Other Job Requirements

Responsibilities

Must have an active pharmacy technician licensure or registration in accordance with state requirements.

If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).

In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).

Active Pharmacist license supersedes requirement for CPT and/or PTCB.

Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.

In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).

Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.

Excellent written and verbal communication skills.

Ability to follow clinical criteria and instructions to approve prior authorization requests.

Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.

Ability to identify and trouble-shoot problematic issues.

General Job Information

Title

Remote Pharmacy Technician- Call Center

Grade

17

Work Experience - Required

Pharmacy

Work Experience - Preferred

Education - Required

GED, High School

Education - Preferred

License and Certifications - Required

CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

License and Certifications - Preferred

Salary Range

Salary Minimum:

$31,175

Salary Maximum:

$46,765

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.