Lead Pharmacy Technician
Core
Lead a team of pharmacy technicians in a managed care environment, handling coverage determinations, clinical authorizations, and quality assurance processes.
Role type
Lead Pharmacy Technician (Managed Care)
Builds
Coverage determination decisions and clinical authorization approvals for members
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Deliverable
client delivery
Required skills
Pharmacy operations, coverage determination, clinical authorization, quality assurance monitoring, team leadership, training development, provider communication, PBM system navigation
Preferred skills
Specialty pharmacy experience, supervisory experience, hiring and performance management
Technologies
PBM systems
Responsibilities
Deliver rapid quality and process improvement information to the team; Provide guidance to technicians on quality assurance and productivity standards; Train pharmacy technicians on daily tasks; Track and triage coverage determination requests; Obtain verbal authorizations and request clinical information from prescribers; Approve coverage determination requests based on defined criteria; Enter and document decisions into the PBM system; Respond to client inquiries regarding approvals; Refer specialty drug requests to delegated vendors; Contact providers for additional information to facilitate reviews; Notify physicians, providers, and members of decisions.
Seniority
Lead, hands-on IC with supervisory responsibilities