Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Clinical Informatics Prior Authorization Call Center Experience ICD 503 Escalation Management Medical Abbreviations Clinical Data Analysis Reimbursement Regulations Prior Authorization Pharmacy Benefit Management QR Codes Internal Documentation Medication Dispensation Process Improvement Online Communication

Other Skills

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Training And Development
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Coaching
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Research
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Troubleshooting (Problem Solving)
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Microsoft Office
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Mentorship
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Non-Verbal Communication
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Teamwork
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Problem Solving

Roles & Responsibilities

Pharmacy Technician certification/licensure per state requirements (CPT/LPT/PTCB/RPT); in Florida, Rhode Island and Michigan license registration with the Board of Pharmacy is required without exception.
PTCB certification; in states requiring a Pharmacy Technician certification/registration exam, state certification/registration may substitute for the PTCB.
2+ years dispensing or retail experience (or equivalent internal training); health plan/health care setting experience and/or previous reimbursement experience.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic/reimbursement coding (J/Q codes, ICD-9, CMS 1500); proficiency with pharmacy computerized systems and MS Office; excellent written and verbal communication; ability to follow clinical criteria to approve prior authorization requests.

Requirements:

Determine appropriateness of medications and communicate decisions to physicians, staff and pharmacists; research, resolve and document prior authorization outcomes in the pharmacy system.
Communicate selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, office staff, medical management staff and pharmacists; escalate complex requests to Pharmacist for extensive clinical review.
Monitor telephone system to ensure adequate staffing and maintain client service levels; assess training needs within the team and serve as a training resource, mentor and coach to others.
Identify and share best practices; demonstrate, advocate and reinforce a positive team environment; perform other duties as assigned.

Saviance Technologies Pvt. Ltd.

About Saviance Technologies Pvt. Ltd.

Saviance Technologies is a US Healthcare IT Service provider focusing on Patient Engagement with Innovative Products and Solutions like Patient Intake Tablet, iHealthConnect Wellness Portal, Mobile Applications, Actionable Analytics and ICD-10 Testing Services. Incorporated in 1999 in New Jersey, with over 15 years of excellent industry track record, Saviance offers services & solutions that enable enterprises to achieve critical objectives. Saviance is a Gold Category Corporate Member with Healthcare Information Management Systems Society (HIMSS), member of mHealth Alliance and Corporate member of NJ-HITEC. We are awarded by INC. 5000 as one of the fastest growing privately held companies in North America. Saviance is also ranked among the Fast 50 Asian American Businesses in the United States by USPAACC (US Pan Asian American Chamber of Commerce) and selected as a 2014 "Top Business" recipient byDiversityBusiness.com. A certified Minority Business Enterprise recognized by NMSDC, Saviance is also partner with leading global brands such as Microsoft, Amazon Web Services, Apple, Samsung and Red Hat.

Company type: SME

Founded: 2018

Company size: 51 - 200

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Job description

Job Title: Clinical Pharmacy Technician II

Job Location: Remote Orlando, FL

Duration: 3-6+ Months may be able to convert to FTE

Client: Magellan Health Req# 723-1

Job Description

JOB DESCRIPTION: 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. Monitors telephone system to ensure adequate staffing to maintain client services levels. Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices. Demonstrates, advocates and reinforces a positive team environment. Other duties as assigned. RESPONSIBILITIES: CPT: Certification/licensure in accordance with state requirements. In the states of Florida, Rhode Island and Michigan, license registration with the Board of Pharmacy is required without exception. PTCB: Certification; Workers in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the 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 2 years dispensing or retail experience required, or equivalent internal training will be substituted. Ability to identify and trouble-shoot problematic issues. WORK EXPERIENCE: Pharmacy 2+ years CERTIFICATIONS: CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements EDUCATION: High School Diploma or GED (Required)