Healthfirst New York Jobs

The Pharmacy Technician position is a dynamic position responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The Pharmacy Technician is responsible for approval decisions/denial recommendations based on predetermined clinical criteria, updates to units requested, decision notification for members and providers, establishing good rapport with Provider offices, strong communication and customer service skills. The Pharmacy Technician position is part of multidisciplinary team and will work closely with Providers, Pharmacists, and Medical Directors. The Pharmacy Technician will report to the Clinical Pharmacist.

Duties & Responsibilities:Review prior authorization requests and units for medications requested under the medical benefitAssess provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteriaTelephonic/ fax/ mail notification to members and providers of authorization decisionsEnsure prior authorization reviews are conducted in time-frames set forth by CMS and/or NYSDOHEstablish great rapport with Provider offices via telephonic communicationSend Providers request for information sheetsEnsure that patient information is always shared appropriately maintaining confidentiality and compliance with federal/HIPAA regulationsAdditional duties as assignedMinimum Qualifications: Pharmacy Technician with active national Pharmacy Technician Certification Board (PTCB) certificate or active Pharmacy Technician License in the state of New York Minimum of 1 year experience conducting prior authorization reviewsStrong clinical backgroundStrong written and verbal communication skills in EnglishDemonstrated critical thinking and problem-solving skillsTeam player with a passion for learning and interest in growing skills in a dynamic environment with various opportunitiesStrong telephonic communication skillsPreferred Qualifications:Strong written and verbal communication skills in Chinese, Spanish, or RussianKnowledge of specialty pharmaceuticals and billing practices in the medical benefitKnowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage DeterminationsPC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).Experience with TruCare Care Management PlatformLicense or Certification: Certified Pharmacy Technician in the state of NY in good standing.Regulatory or Compliance activities:Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400

• All Other Locations (within approved locations): $41,101 - $60,320

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.