Clinical Pharmacy Technician | JobSetuu

Description

Job Overview

• Source: Jobicy

Job Description

Description

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

Position Summary

• Our Clinical Pharmacy Technician processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.
• Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication. Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.

Roles

• Process and finalize PA requests within clients’ turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines. 
• Accountable for achieving prior authorization processing productivity and accuracy standards

Major Responsibilities or Assigned Duties

• Enter prior authorizations into the system and prioritize requests. 
• Check formulary alternatives and review tried and failed medications.
• Utilize drug references and verify the drug being requested is indicated and approved for the condition. 
• Document all related information regarding the PA approval or non-approval. 
• Conform to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision-making. Partner with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Analyze, research, and resolve prior authorization processing issues, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from supervisor or clinical pharmacists; and referring unique or high dollar requests to supervisor according to guidelines. 
• Coordinate within client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests.
• Document prior authorization-related information and status.
• Make outbound calls to obtain information and answer questions about prior authorization status.
• Protect and maintain confidentiality and privacy of all prior authorization and member information, including following strict protocols for date stamping and storage/security of prior authorization forms and related information.
• Identify and recommend operational improvements.
• Participate in and support all applicable Quality Management initiatives
• Maintain a flexible schedule to meet client needs, as needed 
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Adapt to the differences of clients
• Support all Compliance Program activities
• Complete other duties and responsibilities as directed

Position Levels

Each level attained compounds responsibilities with those of prior level(s).

Clinical Pharmacy Technician I:

• Production should increase regularly, from 1-3 to 7 Prod steps/hour
• Quality should increase regularly, with expected minimum rate of 95%

Clinical Pharmacy Technician II:

• 3-month Production average should meet or exceed 7 Prod steps/hour (100%)
• 3-month Quality average should meet or exceed 96%
• No PIPs or CAPs in prior 3 months for any reason
• Completed all training checklists for department and demonstrated proficiency with position processes and PG clients
• Participate in the weekend rotation process
• Proficient with all position processes and team clients’ expectations
• Demonstrate ability to create training documents/presentations

Clinical Pharmacy Technician III:

• 3-month Production average should meet or exceed 8.3 Prod steps/hour (118%)
• 6-month Quality average should meet or exceed 98%
• No PIPs or CAPs in prior 6 months for any reason
• Effectively manage PANF reports, daily assignments, LOI, and Outreach calls
• Demonstrate problem solving and ability to work cross-functionally for new projects and HQs
• Demonstrate ability to train other PACs on HQ/processes and provide constructive feedback
• Effectively assist with monthly audits when asked
• Correctly approve PAC I-II Overdollar requests, as well as own
• Participate in special projects, lead committees, or pilot new processes/improvements

Clinical Pharmacy Technician IV:

• 3-month Production average should meet or exceed 9.7 Prod steps/hour (138%)
• Effectively regularly assist with monthly audits and calibration calls
• Cross trained on RxAdvance process/system and capable of filling in at any time
• Participate in the weekend rotation and weekend leadership on-call process
• Effectively train and mentor new hires from day 1 overview to end of 120 days, including weekly training meetings
• Participate in the Customer Advocate Program
• Effectively cover the floor without a supervisor, including for escalated calls or emails

Requirements

Skills and Experience

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice 
• Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc. 
• Strong organizational skills with attention to detail
• Strong oral and written communication skills
• Excellent critical thinking capabilities with a strong attention to detail
• Exceptional customer service skills
• Minimum one-year prior authorization experience preferred
• Health plan or Pharmacy Benefit Manager experience preferred

Education

• High school diploma or equivalent
• Active Certified Pharmacy Technician (State or National License)

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com. 

Expert Career Tips for Clinical Pharmacy Technician Roles

To succeed in a competitive market as a Clinical Pharmacy Technician, you need more than just technical skills. Here are some expert strategies to elevate your profile:

• Build a Strong Portfolio: For technical roles, a clean GitHub or a personal project site is essential. For non-technical roles, a case study portfolio demonstrating problem-solving and impact is equally valuable. Show, don't just tell, what you have achieved in your previous positions.
• Master the Narrative: When interviewing, use the STAR method (Situation, Task, Action, Result) to structure your answers. Quantify your results wherever possible—mentioning "increased efficiency by 20%" is much more impactful than saying "improved efficiency."
• Continuous Learning: The industry moves fast. Whether it's staying updated with the latest AI tools or mastering a new management methodology, continuous professional development is key. Consider obtaining industry-recognized certifications that align with Clinical Pharmacy Technician requirements.
• Networking: Connect with other professionals in similar roles. Join online communities, attend webinars, and engage in meaningful discussions on professional social networks. Often, the best opportunities come through referrals and community engagement.
• Soft Skills Matter: Communication, empathy, and leadership are often the deciding factors between two equally qualified technical candidates. Cultivate these skills as they are universally valued across all industries and seniority levels.

Additionally, research the specific company's culture and values. Tailoring your application to show how you align with their mission can significantly increase your chances of moving forward in the process.

Salary & Compensation

Salary not disclosed; typically competitive for the role.

Work Arrangement

Type: On-Site

Standard business hours at the office.

Comprehensive Application Strategy & Hiring Process

Applying for a new role is a marathon, not a sprint. Follow this strategic approach to maximize your success rate:

1. Initial Research & Tailoring

Don't send the same resume to every employer. Spend at least 30 minutes researching the company. Look for recent news, their product roadmap, and their team structure. Modify your summary and core competencies to reflect the specific keywords found in the job description.

2. The Perfect Cover Letter

If the application allows for a cover letter, use it to tell a story that your resume cannot. Explain why you are passionate about this specific company and how your unique background makes you the perfect fit for the challenges they are currently facing.

3. Navigating the Multi-Stage Interview

Most modern hiring processes involve 3-5 stages. This typically includes a recruiter screen, a technical or skill-based assessment, a peer interview, and a final leadership round. Prepare for each stage differently: focus on enthusiasm and fit for the recruiter, technical depth for the assessment, and strategic vision for the leadership round.

4. Post-Interview Follow-Up

Always send a personalized thank-you note within 24 hours of each interview. Reference a specific topic discussed during the call to demonstrate your active listening and genuine interest in the role.

By following these steps, you demonstrate a high level of professionalism and attention to detail that sets you apart from the average applicant.

Typical Interview Process

1. Resume screening
2. HR call
3. Skill interview
4. Final manager interview
5. Offer

Tip: Research the company's products and culture.

Global Market Intelligence & Relocation Insights

At JobSetuu, we specialize in helping talent navigate the global job market. Here is what you need to know about the current landscape in Global and beyond:

The demand for skilled professionals is increasingly borderless. For roles based in Global, understanding the local cost of living, visa requirements (if applicable), and cultural nuances is vital. If this is a remote role, consider the time zone alignment and the asynchronous communication culture of the hiring organization.

Relocation Support: Many forward-thinking companies offer relocation packages that include moving stipends, temporary housing, and legal assistance with work permits. When evaluating an offer, look beyond the base salary—consider the total compensation package, including equity, bonuses, and healthcare benefits.

Work-Life Balance Trends: Hybrid and remote work have become standard in many regions. Research the local labor laws and common practices regarding work hours and vacation time to ensure the role aligns with your lifestyle goals.

Leveraging JobSetuu's tools can help you compare salaries across different cities and understand the "purchasing power" of your potential offer, ensuring you make an informed decision for your long-term career path.

Skills & Competency Roadmap for Professional Development

To remain competitive in Professional Development, we recommend focusing on the following core competencies over the next 12-18 months:

• Technical Mastery: Deepen your expertise in the core tools and languages relevant to your field. For developers, this might be cloud architecture; for marketers, it might be data-driven attribution modeling.
• AI Augmentation: Learn how to leverage generative AI and automation tools to increase your productivity. Understanding how to integrate these technologies into your workflow is becoming a non-negotiable skill.
• Leadership & Strategy: Even in individual contributor roles, the ability to think strategically and lead projects from inception to completion is highly valued. Focus on stakeholder management and high-level project planning.
• Data Literacy: The ability to interpret data and use it to drive decisions is essential across all business functions. Familiarize yourself with data visualization and basic analytical concepts.

By investing in these areas, you not only prepare yourself for the role you are applying for today but also build a resilient foundation for the opportunities of tomorrow.

Apply via JobSetuu

Discover your next career milestone on JobSetuu. This Clinical Pharmacy Technician position is part of our commitment to bringing you the most relevant and high-impact job openings globally. At JobSetuu, we simplify your job search by aggregating premier listings and providing the tools you need to stand out. Don't miss the chance to elevate your professional journey—explore more opportunities and career insights on our platform today.