Job Description

Position is onsite in Coral Gables, FL. 

As a Certified Pharmacy Technician, you will be responsible for answering incoming calls and initiating any necessary outbound calls to providers and pharmacies. You will also be responsible for reviewing requests from members, physicians and pharmacies to determine whether medication coverage can be authorized based on benefit plan design, client specifics and clinical criteria. You’ll need to work within multiple computer systems and platforms simultaneously as you respond to questions or provide specific medication details / clinical information in a timely manner to obtain a prompt and accurate response.

KEY RESPONSIBILITIES:

• Provide support in obtaining supporting statements and clinical information necessary for coverage determinations
• Explain the Plan’s formulary, formulary structure and different benefit stages
• Enter and maintain accurate prior authorization records
• Answer provider calls as this is a provider call center for pharmacy inquiries and effectively communicate processes and benefits
• Consult with pharmacists and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested
• Respond to inquiries from other departments, physicians and members related to formulary and prescription benefits
• Participate in various Pharmacy-related projects 
• Review pharmacy claims for appropriateness
• Perform Quality Assurance audits. 
• Work schedule between the hours of 8AM and 6PM, Monday through Friday [shifts available include: 8AM – 5PM and 9AM – 6PM (with one hour of lunch)]. Will work remotely on weekends and holidays (alternating with other CPhTs) on an “on-call” basis.

The above statements reflect the general duties considered necessary to describe the principal functions of the position identified and shall not be considered a detailed description of all work requirement inherent to the position.

QUALIFICATIONS:

• State of Florida Certified Pharmacy Technician License (CPhT) required 
• Managed Care Pharmacy experience desired
• Retail Pharmacy Experience preferred
• Bilingual (English/Spanish) required
• Knowledge of pharmaceutical generic and brand names
• Strong Microsoft software and computer skills (Word, Excel, Powerpoint, Access, Outlook) 
• Efficiency in a fast-paced environment
• Team player

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