Remote UM Pharmacy Technician

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.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Hea