Remote Pharmacy Technician (US: FL, IL, IN, WI)

The Offer
? Opportunity within a company with a solid track record of performance
? A role that offers a breadth of learning opportunities
? Fantastic work culture

Ideal Candidate

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.

The Profile
? You have at least 2 years experience within a Customer Service role, ideally within the Hospital / Health Care / Healthtech, Pharmaceutical industry.
? You possess excellent interpersonal as well as written and verbal communication skills.
? You pay strong attention to detail and deliver work that is of a high standard
? You are a self-starter and demonstrate a high level of resilience
? You are a strong team player who can manage multiple stakeholders
? You have a University Degree - Certified Pharmacy Technician (Required).
? Licensed in Florida, Illinois, Indiana, or Wisconsin (Required).
? Fluent in English (US) (Required) to effectively liaise with stakeholders in the region.
? Living in the USA due to HIPAA compliance.
? 4 to 6 years of supply chain or customer support service experience (Preferred)

The Employer

Our client is a Centralized and Standardized Native Customer Support Services Worldwide Sole provider of all Major Languages and Dialects in the World International Marketplace of Premium Contact Center Projects for Remote Talents

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