Medication Therapy Management Technician
Employment Information
Job Description
Medication Therapy Management Technician evaluating pharmacy requests and authorizing approvals. Communicating with healthcare professionals and maintaining high-quality client service in pharmacy system.
Responsibilities:
- Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
- Determines appropriateness for medications.
- Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists.
- Researches, resolves and documents prior authorization outcomes in pharmacy system.
- Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.
- Escalates requests to Pharmacist when request requires extensive clinical review or denial.
- Monitors telephone system to ensure adequate staffing to maintain client services levels.
- Assesses training needs within the team.
- Serves as a training resource, mentor and coach to others.
- Identifies and shares best practices.
- Demonstrates, advocates and reinforces a positive team environment.
Requirements:
- Education Level GED High School Required
- CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
- 2+ years Pharmacy
- Must have an active pharmacy technician licensure or registration in accordance with state requirements.
- Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
- In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.)
- Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
- Excellent written and verbal communication skills.
- Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted.
Benefits:
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Professional development opportunities
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