CPhT Utilization Management Technician

Job Summary

Supporting utilization management efforts, the remote CPhT Utilization Management Technician will assist in processing coverage requests, coordinating with healthcare providers, and ensuring compliance with regulatory standards.

Key responsibilities

• Facilitate utilization management requests and enter authorizations into the claims platform
• Coordinate with members and providers regarding specialty management programs and prior authorizations
• Make outbound calls to obtain missing clinical information for submitted cases and ensure timely reviews

Required qualifications

• 1-2 years of experience as a pharmacy technician in a PBM or managed care setting
• Active National Certified Pharmacy Technician (CPhT) certification
• Knowledge of pharmacy claims adjudication and benefit designs
• Experience in a call center environment with the ability to multitask and prioritize work
• Associate's or Bachelor's degree preferred