The CSI Companies, a National staffing company, is seeking a Pharmacy Technician to work for one of our clients in the Spring Hill, FL area. This is a full time role, with potential to go permanent with the client.
Long term contract position with potential to go permanent
Hours: 9-5, M-F
Qualifications, Education and/or Experience
Bachelor’s degree, Certified Pharmacy Technician Certificate or Degree, or equivalent experience preferred
4 to 6 years of progressive experience in the PBM, Part D Program, Pharmacy Operations and/or Managed Care preferred
Proficient in working with Microsoft Office software, including Microsoft Excel, Power Point, and Word as well as MS Internet Explorer.
Florida Technician registration required
Essential Duties and Responsibilities
Oversees the clinical decisions of the PBM ensuring clinical criteria meet guidelines and recommends a coverage determination decision on approvals and/or denials when necessary.
Follows up with Member or Providers as needed to obtain or verify additional information and record completeness and accuracy of coverage determination cases.
Communicates with PBM, Pharmacist and/or Members to provide updates and/or resolution of coverage determinations.
Document case detail information to include date and time or receipt, investigation, verbal and written communication, resolution, parties involved in all pertinent internal and PBM systems to ensure data integrity for CMS and NCQA audits.
Ensures timely processing and review of functions to meet CMS and NCQA standards as well as specific company goals.
Ensures prescription coverage provided to eligible members are appropriate based on benefit design and appropriateness of medications for condition are being utilized. (i.e.: formulary management, tier and quantity exceptions, brand limits, etc.)
Collaborate with PBM and internal departments on the implementation of clinical initiatives and strategies that help improve the members’ health, well-being and outcomes.
Responds to requests from member service, and appeals and grievance on any issues relating to the Prescription Drug Program.
Performs additional duties and/or projects as assigned.
Must be able to pass a drug and background check.