Clinical Pharmacy Technician II

Orlando FL 32812

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.

Essential Functions

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- On behalf of health plan clients, manages all prior authorization requests for specialty injectable medications, ensuring appropriate injectable product selection, step-edit management, therapeutic protocol adherence, medication dosing adjustments, assay management, concomitant medication prescribing and specialty pharmacy selection.

- Maximize Magellan Rx Management specialty pharmacy medication dispenses via execution of UM protocols. Proactively suggest the use of ICORE for providers and/or members in an “Any Willing Provider” state and those who are not required to use ICORE Pharmacy exclusively. Ensure that the appropriate documentation is sent to Magellan Rx Management Specialty Pharmacy in a timely manner. Provide communication to Magellan Rx Management pharmacy staff on status of authorization as needed.

- Utilize MRxAuth and other platforms ensuring all cases are accurately entered and documented. Continuously monitor the status of unresolved cases via intra-day reporting methods and ensure they are resolved in a timely manner. Ensure that authorization requests for non-preferred products are correctly routed within MRxAuth and provider outreach has taken place to educate on Plan’s preferred formulary.

- Manages all case information, paperwork and supportive documentation required for completion of authorization process and successful claims processing. Ensure that the health plan receives daily ATE report and Issue Logs where applicable. Perform updates to cases within MRxAuth once plan has provided a final determination.

- As the end user and system expert, proactively suggest changes/updates to the prior auth application that ensures maximum protocol adherence, suggest processes to help improve overall efficiency and increased health plan customer satisfaction.

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

4/24/2019

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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