Remote Pharmacy Technician (US: FL, IL, IN, WI)
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
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 plans 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
You have at least 2 years experience within a Customer Service role, ideally within the Hospital / Health Care / Healthtech, Pharmaceutical industry.
You possess excellent interpersonal as well as written and verbal communication skills.
You pay strong attention to detail and deliver work that is of a high standard
You are a self-starter and demonstrate a high level of resilience
You are a strong team player who can manage multiple stakeholders
You have a University Degree - Certified Pharmacy Technician (Required).
Licensed in Florida, Illinois, Indiana, or Wisconsin (Required).
Fluent in English (US) (Required) to effectively liaise with stakeholders in the region.
Living in the USA due to HIPAA compliance.
4 to 6 years of supply chain or customer support service experience (Preferred)
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
Apply Now
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
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 plans 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
You have at least 2 years experience within a Customer Service role, ideally within the Hospital / Health Care / Healthtech, Pharmaceutical industry.
You possess excellent interpersonal as well as written and verbal communication skills.
You pay strong attention to detail and deliver work that is of a high standard
You are a self-starter and demonstrate a high level of resilience
You are a strong team player who can manage multiple stakeholders
You have a University Degree - Certified Pharmacy Technician (Required).
Licensed in Florida, Illinois, Indiana, or Wisconsin (Required).
Fluent in English (US) (Required) to effectively liaise with stakeholders in the region.
Living in the USA due to HIPAA compliance.
4 to 6 years of supply chain or customer support service experience (Preferred)
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
Apply Now