Job Description
The Offer
- Leadership Role
- A role that offers a breadth of learning opportunities
- Opportunity within a company with a solid track record of performance
The Job
Position Overview:
- We are seeking seven Remote Pharmacy Technicians based in the US Licensed in Illinois, work for a premium client in the medical field. This is a fully remote/work-from-home position providing support to customers.
Key Responsibilities:
- Reviews pertinent patient information and checks appropriateness using clinical criteria. Makes approval recommendations on all services that meet clinical review criteria. Refers all cases not meeting clinical criteria to pharmacist clinical reviewer.
- Practices and maintains the principles of utilization management by adhering to the company policies and procedures. Upholds clinical integrity of pharmaceutical solutions by participating in ongoing training programs to ensure quality performance in compliance with applicable standards and regulations. Expert within the organization.
- Assists with the documentation and implementation of both written and verbal communications to physicians/prescribers and assists in the maintenance of the edits and data elements that support the edits.
- Available for consultation in pharmacy related questions to resolve claims submission related to medication edits.
- Contacts physicians/prescribers to obtain pertinent clinical history/information. Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plan`s required timeframes.
- Regularly reviews and monitors information on pended claims identified as outliers by internal and/or external analysis of pharmacy claims data.
- Supports Intake call volume and order entry if necessary.
- Determines eligibility for medication reimbursement based upon established clinical criteria and clinical knowledge and enters approvals or denials in the system.
- Electronically documents both written and verbal communications with physicians, their staff, cardholders, and pharmacies.
- Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when further review is necessary.
- Other duties as assigned.
Training Program:
- Five weeks of paid training starting in September.
- Training is fully remote/work-from-home.
- $18 Training Hourly Rate
Why Join Us?
- Work from the comfort of your home.
- Hourly rate of $20 after completing the training.
- Opportunity to be part of a revolutionary and multicultural company.
- Continuous professional development and support.
The Profile
Requirements
- University Degree - Certified Pharmacy Technician (Required)
- Licensed in Florida, Illinois, Indiana, or Wisconsin (Required)
- Fluent in English to effectively liaise with stakeholders in the region
- 4 to 6 years supply chain or customer support service experience (Preferred)
Internet:
- Broadband internet connection
- Ethernet-based LAN connection
Hardware Requirements:
- Processor: 1.8Ghz upwards (64bit preferable)
- RAM: 4 GB RAM upwards
- Available Storage: 10Gb minimum
- Preferred Resolution: 1920x1080
- Wired USB Headset
Operating System
- Microsoft Windows: 10 or upwards
- Mac OSX: 11 or upwards
Benefits
- Home-based working with a competitive salary
- Project-based opportunities
- Long-term cooperation agreement
- Career development
- Gamification program (make more money, get holiday paid hours)
The Employer
Our client is a Revolutionary Multilingual Cloud Contact Center and the International Marketplace of Premium Customer Support Projects for Remote Talents. The company is on the mission to reinvent professional Home-Based Working, build the Workplace of the Future, and make Outsourcing Uniquely Simple and Flexible like never before.
Job Tags
Hourly pay, Holiday work, Part time, Remote job, Flexible hours,