Utilization Management Pharmacy Technician
Utilization Management Pharmacy Technician
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Job Description
ABOUT THE ROLE:
The Pharmacy Technician (CPhT) Utilization Management is a member ofthe RightwayRx Operations team. This role will assist UM leadership in delivering on our UMstrategy and actively work UM cases.
Our pharmacy benefit management (PBM) offering represents an importantgrowth area for Rightway. Helping clients better manage pharmacy spend to make moreaffordable for their employees and dependents is critical to their business is responsible for designing building and operating a newtotheworld PBM modelbase on our core tenets: fairness & transparency unlocking the supply chain supporting thephysicianpatient relationship and utilizing navigation to empower consumers
WHAT YOULL DO:
- Support all lines of business via facilitating the process for utilization managementrequests for coverage entering authorizations into the claims platform and facilitatingmember and provider communications
- Provides support to members enrolled in specialty management programs including coordinating any needed prior authorization with the UM team the fulfillment of the prescription with the specialty pharmacy partner enrollment in patient assistance programs and billing questions.
- Coordinate with Pharmacy technicians Pharmacists and/or Medical Directors on UM activities
- Make outbound calls to provider offices to obtain clinical information missing from UM submitted cases
- Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
- Participate in the quality review and interrater reliability processes
- Provider call center: answer prescriber inquiries about the status UM requests
- Ensures regulatory and privacy standards are consistently met.
WHO YOU ARE:
- Associates or Bachelors degree preferred
- 12 years experience in a pharmacy technician role within a PBM pharmacy department of a health plan or similar managed care setting. Or 12 yearsexperience working in a mail order or specialty pharmacy
- Active Certified Pharmacy Technician (CPhT)
- Detailoriented critical thinker empathetic ability to dig deep in understanding an issue to get to true root cause and resolution desire to improve a patients healthcare experience and provide concierge level service.
- Knowledge of pharmacy claims adjudication and benefit designs/terminology call center experience ability to multitask and prioritize work ability to work independently.
SALARY: $2122/hr
CYBERSECURITY AWARENESS NOTICE
In response to ongoing and industrywide fraudulent recruitment activities (i.e. job scams) Rightway wants to inform potential candidates that we will only contact them from the @ email domain. We will never ask for bank details or deposits of any kind as a condition of employment. If you have any questions about a suspicious interaction with Rightway please feel free to reach out to us at
ABOUT RIGHTWAY:
Rightway is on a mission to harmonize healthcare for everyone everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patients care journey through a modern mobile app. Rightway is a front door to healthcare giving patients the tools they need along with ondemand access to Rightway health guides human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017 Rightway has raised over $130mm from investors including Khosla Ventures Thrive Capital and Tiger Global at a valuation of $1 billion. Were headquartered in New York City with a satellite office in Denver. Our clients rely on us to transform the healthcare experience improve outcomes for their teams and decrease their healthcare costs.
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
Were seeking those with passion for healthcare and relentless devotion to our goal. We need team members who will:
- We are human first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with whether it be our members our clients or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen toand heareach other we celebrate our differences and similarities we are present for each other and we strive for mutual understanding.
- We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries other leaders and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
- We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution we actively listen to one another approach it with a yes and mentality and assume positive intent. Once a decision is made we align and champion it as one team.
- We cultivate grit
Changing healthcare doesnt happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations we value persistence. We embrace failure as a stepping stone to future success. On this journey we seek to act with guts resilience initiative and tenacity.
- We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team we each play a crucial part in our members care and take that responsibility seriously. When faced with an obstacle we are kind respectful and solutionoriented in our approach. We hold ourselves accountable to our clients and our members success.
Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes beliefs background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit qualifications need and performance.
Required Experience:
IC
Employment Type
Hourly
