Pharmacy Technician (Pharmacy Services 2)
Remote in California
7+Months
8:30 AM to 5:00 PM
 

Summary: The main function of Pharmacy Services is to provide efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members and brokers) and internal team members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review and consumer affairs issues. Job Responsibilities: Under general supervision, coordinates, assists in and supports implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit. Communicates with the physician, physician’s office staff, medical management and other team members to assist with accurate and efficient resolution of prior authorization requests Assists in providing formulary alternatives and communicates prior authorization criteria, and discusses pharmacy benefit coverage inclusions/exclusions when required Interfaces in a courteous and professional manner with physicians, physician office staff, contracted pharmacists, patients, and other team members during the prior authorization process Provides drug usage history and other pertinent pharmacy benefit related computer searches for pharmacists and Medical Director to assist in case specific reviews and drug evaluations. Assists pharmacists with drug utilization review programs, NCQA QI programs or other assigned projects Communicates prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physician, physician office staff, medical management staff, sales, member/customer services Assists in research and resolution of physician inquiries and grievances Provides essential clinical information to Member Services, Administrative Review Department and Consumer Affairs to resolve Member inquires and grievances Education and Experience: Currently in training or recently completed training but has not consistently reached production/quality standards 2-4 years’ experience required. Your Role The UMRx Prior Authorization Technician team is primarily responsible for ensuring accurate and timely review of IV and injectable medications under the medical benefit, using  Pharmacy and Therapeutics (P&T) Committee medication polices. The Pharmacy Technician, Advanced, will report to the Operations Supervisor. In this role you will provide support for staff pharmacists using operational expertise to prepare medication cases for clinical review outside of technician EOA. Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management. Responsibilities Utilize medication policy and operational principles to make authorization determination on drug case reviews within technician extension of authority. Research and collect pertinent patient and drug information to assist the pharmacists in case specific reviews and drug evaluations. Ensure coverage determinations are completed within regulatory turnaround times for all lines of business. Work in team environment to manage technician queues. Ability to maintain individual work queue. Communicates with the physicians, physician's office staff, and pharmacies to assist with case resolution. Ability to communicate well with other team members and help to create team synergies. Participates in, evaluates and maintains efficient workflow procedures. Additional activities as assigned and discussed with manager, including participation in all workstreams within UMRx, including but not limited to, intake, system testing, Peer to Peer. Work weekend and holiday rotation schedule. Perform other duties as assigned by the Management Team. Knowledge and Experience  Requires a Certified Pharmacy Technician license Requires at least 2 years of pharmacy related experience and training; or equivalent combination of education and experience. Requires basic job knowledge of systems and procedures obtained through prior work experience or education.

 

About Us: SPECTRAFORCE is one of the fastest-growing workforce solutions firms in the United States. As a diversity-owned business, we place human connection at the heart of everything we do, building strong relationships with both clients and candidates to fill roles successfully. Our teams in North and Central America and India serve more than 150 Fortune clients globally, leveraging custom AI technology to provide direct hire, executive search, nearshoring, offshoring, and project staffing solutions.
 
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.

Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
 
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
 
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer. 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $18.00/hr.