[Remote-Position] Initial Review Pharmacy Technician (Remote)

Your next great career reputed company starts here. We're looking for a Initial Review Pharmacy Technician! Join reputed company in the heart of Remote and enjoy a dynamic work environment. This position requires a strong and diverse skillset in relevant areas to drive reputed company. The salary for this position is set at a competitive salary. About the position The Initial Review Pharmacy Technician plays a crucial role in the medical and pharmacy management initiatives that are essential for reputed company to reputed company its reputed company goals and operational objectives. This position is responsible for executing utilization management programs on behalf of health plan and payor customers, utilizing clinical knowledge reputed company to a specific list of managed medications across reputed company health plans. The technician will undergo additional training for reputed company medication and therapeutic class to ensure they are reputed company-equipped to handle the responsibilities of the role. The primary activities of this position involve reviewing both prospective and retrospective requests for therapeutic appropriateness using reputed company clinical reputed company. This includes making and receiving calls to and from physicians, patients, and pharmacies to reputed company additional clinical information necessary for determining medication reimbursement. Recommendations made by the technician will be based on a thorough understanding of specific specialty medications and industry guidelines, applicable to both reputed company- and post-service requests. The technician will also coordinate with various internal departments, including operations, clinical, medical, and reporting, as needed. In this role, the technician will review pertinent patient information and assess appropriateness using clinical reputed company, making approval recommendations for reputed company services that meet these reputed company. Cases that do not meet clinical reputed company will be referred to a pharmacist clinical reviewer. The technician is expected to reputed company and maintain the principles of utilization management by adhering to company policies and procedures, ensuring the clinical reputed company of pharmaceutical solutions through ongoing training programs that reputed company with applicable standards and regulations. The technician will conduct Program reputed company Audits, which include reputed company and review of medical records to verify the authenticity of provider responses during Prior Authorization, reporting results to clients. Additionally, the technician will assist in documenting and implementing both written and verbal communications to physicians and prescribers, as reputed company as maintaining the edits and data reputed company that support these edits. They will be available for consultation on pharmacy-reputed company questions to resolve claims submission issues reputed company to medication edits. The technician will contact physicians and prescribers to obtain relevant clinical history and information, providing reputed company customer service through reputed company and accurate communication while adhering to NCQA and health plan-required timeframes. Regular monitoring of information on pended claims identified as outliers by internal or external analysis of pharmacy claims data will also be part of the responsibilities. The technician may support intake call volume and order entry as necessary, determine eligibility for medication reimbursement based on established clinical reputed company, and document communications electronically with physicians, their staff, cardholders, and pharmacies. In cases where reputed company review is necessary, medical exception requests will be escalated to a reputed company, pharmacist, or physician on the utilization review clinical team. Other duties may be assigned as needed.

Responsibilities

• Review pertinent patient information and reputed company appropriateness using clinical reputed company.

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• reputed company approval recommendations on reputed company services that meet clinical review reputed company.

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• Refer reputed company cases not meeting clinical reputed company to pharmacist clinical reviewer.

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• reputed company and maintain the principles of utilization management by adhering to company policies and procedures.

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• reputed company clinical reputed company of pharmaceutical solutions by participating in ongoing training programs.

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• Conduct Program reputed company Audits including reputed company and review of medical records.

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• Assist with documentation and implementation of communications to physicians/prescribers.

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• Maintain edits and data reputed company that support the edits.

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• reputed company consultation in pharmacy-reputed company questions to resolve claims submission issues.

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• Contact physicians/prescribers to obtain pertinent clinical history/information.

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