Pharmacy Utilization Management Technician - Now Hiring

Under the direction of the Supervisor, Pharmacy Utilization Management, the Pharmacy Utilization Management (UM) Specialist is responsible for setting up and processing cases in the various applications for drug prior authorization (PA) requests.

Key Responsibilities/Duties – what you will be doing

• Upon set up and processing of PA requests, the Pharmacy Utilization Management Specialist will run test claims for approved authorizations and reach out to members and providers as necessary
• Additional tasks include performing daily quality checks to ensure compliance, managing the Pharmacy UM team email box, responding to provider inquiries, managing electronic prior authorization (ePA) requests, submitting process improvements, among others

Qualifications – what you need to perform the job

Education/Experience:

• High School Diploma or GED
• Associate's degree in Healthcare, Nursing, or a related area or equivalent experience
• Certified Pharmacy Technician (CPhT)
• Minimum of 3 years of pharmacy experience, preferably in managed care/PBM setting

Skills/Abilities:

• Software/Database experience - RxClaims, PAHub, CAS, or MHK is preferred
• Proficient in MS Office - Excel, Word, and PowerPoint Preferred
• Ability to prioritize work when processing pharmacy PA requests per guidelines and within specific turnaround times
• Ability to process high volumes of requests with great accuracy
• Attention to detail and the ability to handle multiple demands, as well as balance multiple priorities in a fast-paced environment
• Good working knowledge of medical terminology
• Must be able to work independently, and as part of a team. Regular interface with various levels of staff and management is required.
• Must be able to exercise appropriate judgement as necessary, following all rules and regulations where required

Working Conditions and Additional Requirements

• This is a hybrid position requiring a minimum of two days in the Canton office per week
• Travel required on an as needed basis. Some early mornings, evenings, weekends, or extended workday may be required as program dictates. Must have flexibility with work schedule

Confidential Data

All information (written, verbal, electronic, etc.) that an employee encounters while working at Point32Health is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R6227