Overview
Healthcare Staffing Expert at The Judge Group | US Healthcare | Strategic Talent Partner | Passive Hiring Expertise
Job Type: 100% Remote role in New Jersey, Pennsylvania, and Delaware
Summary:
The Pharmacy Technician supports retail pharmacy operations while performing utilization management functions to ensure safe, cost-effective, and medically necessary medication use. This role combines traditional dispensing responsibilities with prior authorization review and managed care coordination.
Primary Responsibilities
- Process and dispense prescriptions accurately in compliance with state and federal regulations.
- Review patient profiles and insurance coverage to verify eligibility and benefit plan compliance.
- Perform prior authorization reviews for specialty and high-cost medications using established medical necessity criteria.
- Communicate with prescribers to clarify prescriptions, obtain additional clinical information, and resolve coverage issues.
- Apply critical thinking to assess treatment plans for appropriateness and safety using resources such as Medical Policy, Micromedex, and Care Management guidelines .
- Coordinate with specialty pharmacy vendors for approved authorizations and arrange medication shipment.
- Document all utilization decisions and communications accurately in pharmacy systems and EMR.
- Maintain compliance with state, federal, and accreditation standards for utilization review and pharmacy operations.
- Meet turnaround time and productivity goals for prior authorization and utilization review cases.
Requirements
- Minimum 2 years of experience in retail pharmacy ; prior experience in utilization review, prior authorization, or managed care strongly preferred.
- Knowledge of insurance verification, formulary management, and specialty medication processes.
Seniority level
- Mid-Senior level
Employment type
- Contract
Job function
- Health Care Provider
Industries
- Hospitals and Health Care, Public Health, and Health and Human Services