Pharmacy Technician - Philadelphia - IntePros

    IntePros
    IntePros Philadelphia

    19 hours ago

    $38,000 - $62,000 (USD) per year * Healthcare
    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

    • 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.

    Qualifications

    • Certified Pharmacy Technician (CPhT) designation
    • Minimum 2 years of experience in Utilization Review (UR), Utilization Management (UM), or related clinical review experience

    Preferred:

    • 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
    * This salary range is an estimation made by beBee
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