Job Description
Reviews requests for medical policy or prescription drugs that require a coverage determination based on pre-determined clinical criteria. Provides guidance to providers (doctors and nurses) as well as pharmacies with regard to pharmacy benefits, pharmacy claims, formulary, and pharmacy policy and procedures. Will not be talking to members.
ResponsibilitiesReview requests for medical policy or prescription drugs requiring coverage determination based on clinical criteria.Provide guidance to providers and pharmacies regarding pharmacy benefits, claims, formulary, and policy.Assist with pharmacy-related procedures and ensure adherence to protocols.Essential Skills3 years recent Pharmacy Technician experience including familiarity with drugs, drug categories, pharmacy benefits, and claims.Experience working with difficult customers both in-person and via telephone.6 months experience with computer systems in pharmacy services.Registration as a pharmacy technician in Minnesota (must be active and in good standing).Additional Skills & QualificationsCompletion of a Pharmacy Technician Program.Certification as a Pharmacy Technician (CPhT) (must be active and in good standing).Experience in retail pharmacy settings.Pharmacy and customer service experience.Work Environment
The position is fully remote with dual monitors. The working hours are Monday to Friday from 9:30 AM to 6:00 PM. Once permanent, there will be a Saturday rotation (8:00 AM to 4:00 PM) every 3-10 weeks, with a coordinated day off during the week (usually Monday). Permanent employees will need to go on-site once per month to send letters. The systems used include MedHOK (web-based), MedImpact (PBM), and a few client-specific programs, with limited use of EPIC (view-only). Training will start in person to pick up equipment and meet the manager, followed by remote training for 4-5 months involving shadowing and performing cases. The peak business period is from November through March, with limited time off available during January and February.
Pay and BenefitsThe pay range for this position is $24.66 - $25.66
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position will be accepting applications until Dec 26, 2024.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our peopleThe company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.