Highmark Health Clinical Pharmacy Technician I in Des Moines, Iowa
Job Description :
Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
E1. Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required.
E2. Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines.
E3. Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department.
E4. Maintain regulatory compliance and resolves all cases within predetermined timeframes.
E5. Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary.
E6. Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others.
N7. May perform other non-clinical duties as required by management and department needs.
Certified by the Pharmacy Technician Certification Board (PTCB). Minimum of 2 years’ experience as a Pharmacy Technician in a hospital, retail or managed care setting.
Strong knowledge of medical and pharmaceutical terminology
Strong verbal and written communication skills
Well organized, paying close attention to detail
Ability to identify and resolve problems
Ability to handle multiple priorities in a timely manner
Strong interpersonal skills
Ability to work independently or in a team environment
Proficient with Microsoft Office products (i.e. Word, Excel, Powerpoint, etc.)
Certified Pharmacy Technician
Ability to perform independent research regarding pharmaceuticals and the judgment to make initial decisions and involve pharmacists where necessary.
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Other Job Specifications:
External Contacts: Providers, retail pharmacies, members, vendors
Working Conditions/Physical Demands:
- Must be able to work in an office environment
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description.
Pay Range Minimum:
Pay Range Maximum:
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Req ID: J217974
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