SAI Clinical Pharmacy Support Technician

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Position Summary

Primary responsibility is supporting Formulary Alternative Outreach Program for Medicare Part D.  The Clinical Support Technician will support the operations of the Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This will include outreach calls and faxes to providers, pharmacists, case managers and members, managing day to day processes, analyzing data and organizing and documenting all relevant interactions.

Responsible for reviewing overutilization data and making prescriber and or pharmacy outreach which includes reviewing formulary vs. non-formulary prescription clinical/pharmacy protocol. Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate. Educate providers and pharmacies on formulary vs. non-formulary medications and options for alternative therapies for members. Educates Case Managers on opportunities to enhance medication utilization of members.  Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for member and reverse any unnecessary RX claims while working with pharmacist. Responsible for prescriber outreach for specific Scoreable Action Item initiatives.  Work with team Pharmacist to investigate specific cases of overutilization including potential member outreach to ensure member has received products that have been

dispensed under plan. Maintain expert knowledge in most areas of pharmacy operations. Ability to analyze and interpret various types of complex claim data under member plans. Work with Pharmacy to verify claims information and reverse unnecessary claims.  Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution. Train, coach, and mentor new Clinical Support Technician Staff.

Hybrid Work Schedule:

• Onsite: Tuesday, Wednesday, Thursday
• Work From Home: Monday, Friday

Schedule: Monday - Friday, 9:00a - 5:00p local time

Available Locations:

• Blue Bell, PA
• Moon Township, PA
• Downers Grove, IL

Required Qualifications

• 4 or more years relevant experience
• Valid Pharmacy Technician Certification (PTCB or ExCPT)
• Working knowledge of Microsoft Outlook and Teams
• Ability to interpret Pharmacy Claims data
• Proficiency in computerized pharmacy systems and software applications
• Previous provider/pharmacy outreach experience
• Ability to perform duties with minimal supervision
• Proficient knowledge of Brand/Generic drug names

Preferred Qualifications

• Managed Care experience
• Advanced knowledge of Microsoft Excel and Microsoft Access
• Understanding of medical and pharmacy terminology

Education

• High School Diploma or equivalent

Pay Range

The typical pay range for this role is:

$18.50 - $37.02

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partn