The Offer
- Opportunity within a company with a solid track record of performance
- A role that offers a breadth of learning opportunities
- Fantastic work culture
Ideal Candidate
Position Overview:
Our client is hiring Certified Pharmacy Technicians for a premium medical client. This is a fully remote, work-from-home role requiring candidates to be licensed and residing in Florida, Illinois, Indiana, or Wisconsin.
Key Responsibilities:
- Review pertinent patient information and check appropriateness using clinical criteria.
- Make approval recommendations on all services that meet clinical review criteria. Refer all cases not meeting clinical criteria to pharmacist clinical reviewer.
- Practice and maintain the principles of utilization management by adhering to company policies and procedures.
- Uphold clinical integrity of pharmaceutical solutions by participating in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations.
- Assist with the documentation and implementation of both written and verbal communications to physicians/prescribers and assist in the maintenance of the edits and data elements that support the edits.
- Be available for consultation on pharmacy-related questions to resolve claims submission related to medication edits.
- Contact physicians/prescribers to obtain pertinent clinical history/information.
- Provide optimum customer service through professional/accurate communication while maintaining NCQA and health plan’s required timeframes.
- Regularly review and monitor information on pended claims identified as outliers by internal and/or external analysis of pharmacy claims data.
- Support Intake call volume and order entry if necessary.
- Determine eligibility for medication reimbursement based upon established clinical criteria and clinical knowledge and enter approvals or denials in the system.
- Electronically document both written and verbal communications with physicians, their staff, cardholders, and pharmacies.
- Escalate medical exception requests to nurse, pharmacist, or physician on the utilization review clinical team when further review is necessary.
The Profile
Required Qualifications:
- Active Certified Pharmacy Technician license in Florida, Illinois, Indiana, or Wisconsin (must obtain license before training starts).
- Residence in one of the above states.
- University degree (preferred but not required).
- 4 to 6 years of experience in supply chain or customer service (preferred).
- Proficiency in English with excellent written and verbal communication skills.
- Ability to multitask, prioritize, and work collaboratively in a remote team.
Technical Requirements:
- Reliable broadband internet with a LAN connection.
- Windows 10+ or macOS 11+.
- Minimum 8 GB RAM, 10GB storage, and a USB-wired headset.
Compensation & Benefits:
- Training Rate: $18/hour for the training period (1-2 days).
- Post-Training Rate: $20/hour.
- Flexible hours (30–40 hours per week).
- Opportunity for career growth and long-term cooperation.
- Gamification program with rewards and holiday pay opportunities.
Application Deadline:
Start Date: February 2025
We accept applications until: January 17, 2025.
Join us to be part of an innovative workplace, redefining remote pharmacy services.
The Employer
Our client is a Centralized and Standardized Native Customer Support Services Worldwide Sole provider of all Major Languages and Dialects in the World International Marketplace of Premium Contact Center Projects for Remote Talents.