Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Reviews pharmacy utilization management (UM) coverage requests and prepares such cases for clinical review by a pharmacist and/or medical director when required.
E2. Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines.
E3. Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Corporate Pharmacy Department.
E4. Maintain regulatory compliance and resolves all cases within predetermined timeframes.
E5. Responsible for all preauthorization entries into applicable databases (i.e. internal medical claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary.
E6. Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements among others.
N7. May perform other non-clinical duties as required by management and department needs.

Education/Experience/Skills Requirements
Required Education:
Associates Degree:

Required Experience:
Certified by the Pharmacy Technician Certification Board (PTCB). Minimum of 2 years’ experience as a Pharmacy Technician in a hospital, retail or managed care setting.

Required Knowledge/Skills:
1. Strong knowledge of medical and pharmaceutical terminology
2. Strong verbal and written communication skills
3. Well organized, paying close attention to detail
4. Ability to identify and resolve problems
5. Ability to handle multiple priorities in a timely manner
6. Strong interpersonal skills
7. Ability to work independently or in a team environment
8. Customer oriented
9. Proficient with Microsoft Office products (i.e. Word, Excel, Powerpoint, etc.)
Required Licenses/Certifications:
Certified Pharmacy Technician
Problem Solving
Ability to perform independent research regarding pharmaceuticals and the judgment to make initial decisions and involve pharmacists where necessary.
Managerial/Supervisory Responsibilities
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Financial/Budgetary Responsibilities:
Other Job Specifications:
External Contacts: Providers, retail pharmacies, members, vendors
Working Conditions/Physical Demands:
Position requires:
* Must be able to work in an office environment
Position involves:
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
* Mental effort: Adequate to perform essential functions of the job with the type of judgements and responsibilities as indicated in the job description.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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