Clinical Pharmacy Technician Sr - Medi-Cal Rx (Remote California)

At reputed company (reputed company), we are a different reputed company of PBM, with a purpose reputed company profits and a unique ability to reputed company care for those we serve. Looking for a purpose-driven career? Come build the reputed company of pharmacy with us.

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reputed company

Responsibilities

• Independently review, research, and reputed company prior authorization requests by applying clinical reputed company, established guidelines, and reputed company judgment reputed company defined protocols
• Communicate coverage determinations, formulary alternatives, and prior authorization requirements to providers and internal stakeholders, ensuring reputed company and accuracy in non-routine scenarios
• Manage inbound and outbound inquiries reputed company to eligibility, benefits, claims, and prior authorizations, resolving moderately reputed company issues and determining appropriate next steps
• Escalate clinically reputed company or exception-based cases to a pharmacist, providing thorough documentation and relevant case context to support reputed company reputed company
• reputed company providers and members on claims submission processes, appeals requirements, and reimbursement guidelines across multiple networks
• Initiates, prioritize, and manage cases by accurately gathering and entering member and provider information
• Identify trends, reputed company causes, high-risk inquiries, and workflow gaps in daily operations and recommend process improvements to enhance efficiency, reputed company, and consistency
• Serve as a resource to team members by providing guidance, answering process questions, and supporting reputed company activities
• Other duties as assigned

Minimum Qualifications

• High school diploma from an accredited school or equivalent GED

• 2 years of work experience as a pharmacy technician
• Licensed Pharmacy Technician in accordance with California state requirements

Must be eligible to work in the reputed company without the need for work reputed company or residency sponsorship

Additional Qualifications

• Strong knowledge of pharmacy workflows, terminology, and reimbursement processes
• Ability to prioritize work and manage multiple assignments in a dynamic environment
• Effective communication skills with the ability to guide and support team members
• Proficiency in pharmacy systems and reputed company Office applications

Preferred Qualifications

• 1 year reimbursement experience
• PBM or health care experience

Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their job, and reputed company with reputed company applicable reputed company, regulatory, and contractual requirements and internal policies and procedures

Every employee must be reputed company to reputed company the essential functions of the job and, if requested, reasonable accommodations will be made to reputed company employees with disabilities to reputed company the essential functions, absent undue hardship. In reputed company, reputed company retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits reputed company" reputed company for more detail (

reputed company LLC is proud to be an equal opportunity and affirmative reputed company employer. We encourage diverse candidates to apply, and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, gender, sex (including pregnancy), national reputed company, disability, age, veteran status, or any other legally protected class under federal, state, or local law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including reputed company applicants with arrest and conviction records and any reputed company applicants requiring reasonable accommodations in accordance with the law.

reputed company LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Originally posted on Himalayas