Clinical Pharmacy Technician II

Missouri, Florida

Job Description

This position plays a key role in medical and pharmacy management initiatives critical to Magellan Rx Management in achieving revenue goals and operational objectives. This position is responsible for executing specialty injectable utilization management programs on behalf of health plan/payor customers. This role is often the first point of contact that a Provider’s office or Specialty Pharmacy has when initiating an authorization for injectable or infused product. The position requires communication and teamwork across all internal Magellan departments (Account Management, Specialty Pharmacy, IT, Project Management, Quality), as well as health plan/payor departments (medical management, pharmacy management) and an in-depth understanding of all specialty injectable therapeutic classes, products, trends, current management techniques and industry guidelines. The UM Specialist provides outstanding customer service while also achieving department performance metrics.
  • Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system.
  • Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Monitors telephone system to ensure adequate staffing to maintain client services levels.
  • Assesses training needs within the team.  Serves as a training resource, mentor and coach to others.  Identifies and shares best practices.
  • Demonstrates, advocates and reinforces a positive team environment.
  • Other duties as assigned.

General Job Information

Title

Clinical Pharmacy Technician II

Grade

18

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

4/8/2019

Date Requisition Created

4/8/2019

Minimum Qualifications

Education

GED (Required), High School (Required)

License and Certifications - Required

CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • CPT: Certification/licensure in accordance with state requirements. In the states of Florida, Rhode Island and Michigan, license registration with the Board of Pharmacy is required without exception.
  • PTCB: Certification or the ability to obtain PTCB Certification within one year of hire. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the PTCB.
  • Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
  • In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
  • Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
  • Excellent written and verbal communication skills.
  • Ability to follow clinical criteria and instructions to approve prior authorization requests.
  • Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted.
  • Ability to identify and trouble-shoot problematic issues.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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