Description and Requirements
The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors.
Duties & Responsibilities:
Reviews prior authorization requests and units for medications requested under the medical benefit
Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
Sends notification to members and providers of authorization decisions via telephone, fax, or mail
Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
Establishes great rapport with Provider offices via telephonic communication
Sends request for information sheets to Providers
Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
Additional duties as necessary
Minimum Qualifications:
High School Diploma or GED from an accredited institution
Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
Experience conducting prior authorization reviews
Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional
Preferred Qualifications:
Strong written and verbal communication skills in Chinese, Spanish, or Russian
Demonstrated critical thinking and problem-solving skills
Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local
Coverage Determinations
PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).
Experience with TruCare Care Management Platform
Compliance & Regulatory Responsibilities: Noted above
License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing.
Hiring Range:
Greater New York City Area (NY, NJ, CT residents): $47,403 – $62,400
All Other Locations (within approved locations): $41,101 – $60,320
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
