- Review medical records, treatment plans, and supporting documentation to determine medical necessity using established clinical guidelines and policies.
- Apply critical thinking and sound judgment to make authorization determinations within scope of practice.
- Utilize resources including Care Management Policy, Medical Policy, Micromedex, and Electronic Desk References to evaluate appropriateness of therapy.
- Contact servicing and ordering providers to obtain or clarify clinical information as needed.
- Notify ordering providers and Specialty Pharmacy Vendors of approved authorizations to coordinate medication shipment.
- Verify that requested services are covered under the member's benefit plan.
- Refer cases that do not meet medical necessity criteria to the Clinical Care Coordinator for further clinical review.
- Ensure all utilization decisions comply with applicable federal, state, and accreditation regulations.
- Meet or exceed regulatory turnaround times and departmental productivity standards.
- Accurately document case activities in accordance with Care Management & Coordination policies.
- Maintain data integrity through timely and accurate system documentation.
- Certified Pharmacy Technician (CPhT) designation
- Minimum 2 years of experience in Utilization Review (UR), Utilization Management (UM), or related clinical review experience
- Experience working in a health plan, managed care, or specialty pharmacy environment
- Knowledge of medical necessity criteria and benefit plan review
- Strong communication skills and ability to work independently in a remote environment
-
Pharmacy Technician - Outpatient · Philadelphia, PA 19104 · 11:00 AM - 7:00 PM · 40 Hours/Week · Short Description: · Outpatient Pharmacy Technician required with 2 years of recent outpatient/retail pharmacy experience. Must have strong prescription processing and insurance billi ...
Philadelphia $38,000 - $62,000 (USD) per year1 week ago
-
We're Hiring: Pharmacy Technician I – Ambulatory Retail (Central Fill Specialty Pharmacy) · Join our Central Fill Specialty Pharmacy team at Penn Medicine as an Ambulatory Pharmacy Technician. · ...
Philadelphia1 month ago
-
To fulfill President Lincoln's promise 'To care for those who have served in our nation's military and for their families - caregivers - and survivors' by serving and honoring the men and women who are America's Veterans. · ...
Philadelphia1 month ago
-
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safet ...
Philadelphia $16.50 - $25 (USD)4 weeks ago
-
Outpatient Pharmacy technician. Point of sale, register, data entry in hospital outpatient Pharmacy setting. · ...
Philadelphia3 weeks ago
-
We are seeking a Pharmacy Technician to join our team at CVS Health in Philadelphia. As a Pharmacy Technician, you will support the pharmacy team in delivering operational and service excellence within your store. · ...
Philadelphia $16.50 - $25 (USD) Full time1 month ago
-
We're building a world of health around every individual — shaping a more connected convenient compassionate health experience at CVS Health you'll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselves accountable prioritize safety quality in ...
Philadelphia $16.50 - $25 (USD) Part time1 month ago
-
We're building a world of health around every individual — shaping a more connected, · convenient and compassionate health experience.At CVS Health, · You'll be surrounded by passionate colleagues who care deeply,innoate with purpose,hodl ourselves accountable · & prioritize safe ...
Philadelphia $16.50 - $25 (USD)1 month ago
-
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · ...
Philadelphia $16.50 - $25 (USD) Full time1 week ago
-
Assists pharmacist in preparing and dispensing medications to patients.Identifies prepares packages labels and delivers medications including sterile products under supervision of pharmacist. · ...
Philadelphia Full time1 month ago
-
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · Come join our team of dedicated and caring Pharmacy Technicians who demonstrate our core values of Accountability, Caring, Collaboration, · Innov ...
Philadelphia $16.50 - $25 (USD) Part time4 weeks ago
-
The pharmacy technician supports the organization's mission and purpose by providing front-line customer support for a diverse portfolio of customers. · Provide real-time support to pharmacies with point of service inquiries. · Educate prescribers on formulary and prior authoriza ...
Philadelphia1 week ago
-
Assists the pharmacist in preparing and dispensing medications to patients and patient care areas. · ...
Philadelphia2 weeks ago
-
Job summary · The Pharmacy Technician on the Direct Ship Team plays a critical role in ensuring timely, · compliant, · and medically appropriate medication access for members. · ...
Philadelphia1 month ago
-
Provide real-time support to pharmacies with point of service inquiries. · Educate prescribers on formulary and prior authorization processes. · Enter customer data and other relevant information into our documentation tool.Assist members with pharmacy benefit inquiries. · Adeher ...
Philadelphia1 week ago
-
Certified Pharmacy Technician · The Certified Pharmacy Technician supports the Direct Ship Team within Care Management & Coordination by reviewing clinical documentation and authorization requests to determine medical necessity for pharmacy services. This role applies established ...
Philadelphia $38,000 - $62,000 (USD) per year2 days ago
-
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...
Philadelphia $16.50 - $25 (USD) Part time2 weeks ago
-
We are building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize s ...
Philadelphia $16.50 - $25 (USD)1 month ago
-
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safet ...
Philadelphia $16.50 - $25 (USD)2 weeks ago
-
As a Pharmacy Technician at CVS Health, you will assist the pharmacy team in delivering operational and service excellence within your store. You will be responsible for contributing to safe and effective operations of the pharmacy. Your duties may include living our purpose by f ...
Philadelphia $16.50 - $25 (USD) Full time1 month ago
-
+We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. · +Manage all assigned pharmacy workstations and tasks to support the team's ability to promptly, safely and accurately fill patient prescriptions ...
Philadelphia $16.50 - $25 (USD) Part time2 weeks ago
Pharmacy Technician - Philadelphia - IntePros
Description
Certified Pharmacy Technician
The Certified Pharmacy Technician supports the Direct Ship Team within Care Management & Coordination by reviewing clinical documentation and authorization requests to determine medical necessity for pharmacy services. This role applies established medical necessity criteria, benefit plan guidelines, and internal policies to evaluate treatment requests and facilitate timely medication shipment.
Key Responsibilities
Qualifications
Preferred:
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Full time Only for registered members Philadelphia
-
Pharmacy Technician
Part time Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Full time Only for registered members Philadelphia
-
PHARMACY TECHNICIAN
Full time Only for registered members Philadelphia
-
Pharmacy Technician
Part time Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
PHARMACY TECHNICIAN
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Part time Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Only for registered members Philadelphia
-
Pharmacy Technician
Full time Only for registered members Philadelphia
-
Pharmacy Technician
Part time Only for registered members Philadelphia
