Utilization Management Support Technician
ABOUT THE ROLE:
The Pharmacy Technician (CPhT) – Utilization Management is a member of the RightwayRx Operations team. This role will assist UM leadership in delivering on our UM strategy and actively work UM cases.
Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. RightwayRx is responsible for designing, building and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers
WHAT YOU’LL DO:
Support all lines of business via facilitating the process for utilization management requests for coverage, entering authorizations into the claims platform, and facilitating
member and provider communications
Provides support to members enrolled in specialty management programs, including coordinating any needed prior authorization with the UM team, the fulfillment of the prescription with the specialty pharmacy partner, enrollment in patient assistance programs, and billing questions.
Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases
Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
Participate in the quality review and inter-rater reliability processes
Provider call center: answer prescriber inquiries about the status UM requests
Ensures regulatory and privacy standards are consistently met.
WHO YOU ARE:
1-2 years experience in a pharmacy technician role within a PBM, pharmacy department of a health plan, or similar managed care setting. Or 1-2 years experience working in a mail order or specialty pharmacy
Active (National) Certified Pharmacy Technician (CPhT)
Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service.
Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.
Associate’s or Bachelor’s degree preferred
COMPENSATION: $22.00/hr
Compensation offered will be determined by geographic location, experience, and qualifications.