Pharmacy Technician (US: FL, IL, IN, WI) Position Available In Orange, Florida

Pharmacy Technician (

US:

FL, IL, IN, WI

)
HYBRID
Orlando, Fort Lauderdale, Naperville

Ref:

D9EQIFRXXN

Full Time
Job Engagement
2 – 4 years
Experience
Contract
Job Type
The Offer
100% remote based working
A role that offers a breadth of learning opportunities
Flexible working schedule

The Job Key Responsibilities:

Review pertinent patient information and check appropriateness using clinical criteria.
Make approval recommendations on all services that meet clinical review criteria. Refer all cases not meeting clinical criteria to pharmacist clinical reviewer.
Practice and maintain the principles of utilization management by adhering to company policies and procedures.
Uphold clinical integrity of pharmaceutical solutions by participating in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations.
Assist with the documentation and implementation of both written and verbal communications to physicians/prescribers and assist in the maintenance of the edits and data elements that support the edits.
Be available for consultation on pharmacy-related questions to resolve claims submission related to medication edits.
Contact physicians/prescribers to obtain pertinent clinical history/information.
Provide optimum customer service through professional/accurate communication while maintaining NCQA and health plan’s required timeframes.
Regularly review and monitor information on pended claims identified as outliers by internal and/or external analysis of pharmacy claims data.
Support Intake call volume and order entry if necessary.
Determine eligibility for medication reimbursement based upon established clinical criteria and clinical knowledge and enter approvals or denials in the system.
Electronically document both written and verbal communications with physicians, their staff, cardholders, and pharmacies.
Escalate medical exception requests to nurse, pharmacist, or physician on the utilization review clinical team when further review is necessary. Ideal Candidate Mandatory Requirements Active Illinois Pharmacy Technician License (or must obtain before training begins)
Reside in Florida, Indiana, Illinois, or Wisconsin Qualifications Associate degree or equivalent experience preferred
2 to 4 years of experience in customer service, supply chain, or call center environments (U.S.-based)
Certified Pharmacy Technician preferred
Strong written and verbal communication skills with native English and high-level Spanish
Excellent organizational and interpersonal skills
Ability to multitask in a fast-paced environment
Strong orientation towards metrics and KPIs
Experience interacting professionally with patients, RNs, and medical personnel