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Um pharmacy technician

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Healthfirst

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Location:
United States

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Category:

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Contract Type:
Not provided

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Salary:

42600.00 - 65960.00 USD / Year

Job Description:

The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors.

Job Responsibility:

  • Reviews prior authorization requests and units for medications requested under the medical benefit
  • Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
  • Sends notification to members and providers of authorization decisions via telephone, fax, or mail
  • Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
  • Establishes great rapport with Provider offices via telephonic communication
  • Sends request for information sheets to Providers
  • Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
  • Additional duties as necessary

Requirements:

  • High School Diploma or GED from an accredited institution
  • Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
  • Experience conducting prior authorization reviews
  • Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional

Nice to have:

  • Strong written and verbal communication skills in Chinese, Spanish, or Russian
  • Demonstrated critical thinking and problem-solving skills
  • Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities
  • Knowledge of specialty pharmaceuticals and billing practices in the medical benefit
  • Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
  • PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)
  • Experience with TruCare Care Management Platform
What we offer:

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Additional Information:

Job Posted:
December 09, 2025

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

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