Clinical Pharmacy Technician II
Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza
Job DescriptionThis 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 Functionsbr>- 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 specialty pharmacy medication dispenses via execution of UM protocols. Proactively suggest the use of Magellan for providers and/or members in an “Any Willing Provider” state and those who are not required to use Magellan Pharmacy exclusively. Ensure that the appropriate documentation is sent to Magellan Pharmacy in a timely manner. Provide communication to Magellan 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.
Education: Associates Degree
Experience: 3-5 years
Field(s) of study: Pharmacy Technician certification required (CPhT). Registration with the State of Missouri Board of Pharmacy. Must remain in good standing.
Industry: Specialty or retail pharmacy experience, previous reimbursement experience, and/or working in a health plan/health care setting.
Job Specific: Experience as Pharmacy Tech, Utilization Management or Customer Service in a high-volume, multi-functional call center environment.
An equivalent combination of experience and education is acceptable.
In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/C/Q codes, ICD-10, CMS 1500, etc.). Highly effective verbal and written communication skills.
Computer Skills: proficient in Microsoft Office, Outlook, Excel
Licenses, Certifications, etc.: Certified Pharmacy Technician (CPhT) and Registration with the State of Missouri Board of Pharmacy required.
Education: Bachelors Degree
General Job Information
TitleClinical Pharmacy Technician II
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date8/28/2019
Date Requisition Created8/28/2019
EducationGED (Required), High School (Required)
License and Certifications - RequiredCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Other Job Requirements
- 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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