Healthfirst

The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors.

Duties & Responsibilities:

• Reviews prior authorization requests and units for medications requested under the medical benefit
• Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
• Sends notification to members and providers of authorization decisions via telephone, fax, or mail
• Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
• Establishes great rapport with Provider offices via telephonic communication
• Sends request for information sheets to Providers
• Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
• Additional duties as necessary

Minimum Qualifications:

• High School Diploma or GED from an accredited institution
• Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
• Experience conducting prior authorization reviews

• Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional

Preferred Qualifications:

• Strong written and verbal communication skills in Chinese, Spanish, or Russian
• Demonstrated critical thinking and problem-solving skills
• Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
• Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local
• Coverage Determinations
• PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).
• Experience with TruCare Care Management Platform

Compliance & Regulatory Responsibilities: Noted above

License/Certification:  Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400

• All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.