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Pharmacy Technician- Clinical ProgramWELLDYNE • New York, New York, United States
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Pharmacy Technician- Clinical Program

WELLDYNE
  • US
    New York, New York, United States
  • US
    New York, New York, United States
Jetzt Bewerben

Über

Summary Pharmacy Tech I - Clinical Program is responsible for supporting WellManaged and other clinical solutions within the Clinical Solutions team. The technician will support inbound and outbound calls with members and providers as well as support other clinical program activities. Individuals will follow all policies and procedures related to clinical reviews. Individuals will also support PA operations and will serve as a client service liaison as it relates to prior authorization, as well as participate in training. This position requires strong analytical, strong communication skills, problem solving and decision-making skills. Individuals must have a strong attention to detail with excellent time management skills and must also be proficient in Microsoft applications.
Essential Duties and Responsibilities
Responsible for reviewing clinical prior authorization requests based upon protocols to determine medical necessity.
Answers questions appropriately based upon clinical information submitted by the provider.
Requests additional information from providers as needed for review.
Directs all prior authorization denials to a clinical pharmacist for final review.
Assists in the process of managing appeals.
Accountable for updating clinical program trackers to ensure accurate tracking of all clinical interventions, member communications, and provider communications.
Ensures all prior authorization approvals are placed correctly and in a timely manner.
Interacts with providers and members as appropriate to communicate approval and denial outcomes in compliance with state, federal, and accreditation requirements.
Participates in design and build of prior authorization and step therapy within key systems.
Runs and generates various reports to support operational activities and oversight.
Serves as subject matter expert liaison with client services.
Participate in training.
Apply appropriate policies, procedures, and eligibility and benefit policies.
Maintains confidentiality of all PHI in compliance with state and federal law.
Consistently meets established productivity, schedule adherence, and quality standards, while maintaining a good attendance record.
Other duties as assigned.
Education and Experience
At least 2 years of pharmacy related experience
At least 2 years of customer service-related experience
MS Office Suite knowledge (Which includes the ability to learn new and complex computer system applications)
Knowledge, Skills, and Abilities
Strong telephone, verbal, and written communication skills
Time Management Skills
Teamwork and team building skills
Ability to work independently within a team environment with little direct supervision
Analytical skills
Ability to remain focused and productive each day though tasks may be repetitive
Strong attention to detail and effective follow-up skills
Ability to multi-task
Claim system knowledge
PA Hub knowledge
Positive attitude with excellent customer service mindset demonstrating WellDyneRx commitment to incredible service
Computer proficiency to navigate required databases and operate in required software packages
Demonstrated ability to handle problems tactfully
WellDyne Can Offer You
Medical, Dental and Vision Benefits
Medical Savings Account Options with Company match
401K after 90 days of employment
Employee Assistance Program
Life and Supplemental insurance
Educational Reimbursement
Paid Time Off
Career Pathing
Work Environment / Physical Demands This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients. Some travel may be required.
EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibits discrimination of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected status under federal, state, or local law.
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  • New York, New York, United States

Sprachkenntnisse

  • English
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