Pharmacy Technician I – Medication Access Specialist

Anticipated End Date:

2025-10-10

Position Title:

Pharmacy Technician I – Medication Access Specialist

Job Description:

Be Part of an Extraordinary Team

Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.

Build the Possibilities. Make an Extraordinary Impact.

Title: Pharmacy Technician I – Medication Access Specialist

Location(s): Mason, OH, Indianapolis, IN, Seattle, WA, Atlanta, GA, Miami, FL, Richmond, VA, Las Vegas, NV, Houston, TX

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

As a Pharmacy Technician I – Medication Access Specialist, you will be responsible for the interpretation and data entry of basic prescriptions, handling medication access issues, and troubleshooting adjudication concerns. This role emphasizes problem-solving, communication, and member advocacy.

How you will make an impact: 

• Member Support: Serve as the primary contact for members experiencing medication access issues, providing empathetic and knowledgeable assistance.

• Troubleshooting and Prior Authorization: Identify and resolve barriers to medication access, including insurance pre-authorizations and formulary restrictions. Process prior authorization requests from healthcare providers to ensure compliance with Medicare requirements, and inform relevant parties of determinations.

• Collaboration: Work closely with healthcare providers, insurance companies, and pharmacies to resolve complex medication access cases.

• Education and Communication: Inform members about pharmacy-based rules, alternative medications, and resources for assistance programs. Navigate members through the appeals process when necessary.

• Documentation and Reporting: Accurately document member interactions and generate reports relating to rebates, physician utilization, and other relevant metrics. Maintain records of prior authorizations and monthly reports.

• Continuous Improvement: Suggest process enhancements to improve the member experience by identifying patterns in medication access barriers.

Minimum Requirements:

• Requires H.S. diploma or equivalent and minimum of 1 year of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.

• Current State Pharmacy Tech.

• Certification or National Certification based on applicable state(s) required.

Preferred Skills/Experience/Education:

• CPhT, certified pharmacy technician strongly preferred.

• Experience with Medicaid members strongly preferred.

• Retail pharmacy experience strongly preferred.

• Strong understanding of insurance billing processes and formulary management strongly preferred.

• Problem solving skills preferred.

• Excellent verbal/written communication skills preferred.

• Ability to work independently highly preferred.

• Flexibility highly preferred.

• Compassionate approach to patient care with a strong commitment to service excellence highly preferred.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

If his job is used in Simply Healthcare or Americas First Choice, no UM approval or denial activities will be performed by the associate.

For candidates working in person or virtually in the below location(s), the hourly salary* range for this specific position is $16.92-$29.19.

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