Manage work queues for prior authorizations, high-cost case management, and clinical policy processes. Coordinate communication between physicians, nurses, and members to obtain necessary documentation and drug cost information.
Requirements summary
Requires a Licensed Pharmacy Technician with at least 2 years of managed care experience. Must possess strong communication skills and proficiency in Microsoft Office tools.
professional certificateAttention To DetailCase ManagementWritten CommunicationVerbal CommunicationProblem SolvingMicrosoft ExcelMicrosoft WordMicrosoft PowerPointManaged CarePrior Authorization
Job description
Company Archimedes About Us Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions.
Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.
Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
Pay Range USD $0.00 - USD $0.00 /Hr.
STAR Bonus % (At Risk Maximum) 0.00 - Ineligible Work Schedule Description (e.g.
M-F 8am to 5pm) Remote or hybrid 3 days in office from St.
Louis, MO or Brentwood, TN office Remote Work Notification ATTENTION: Archimedes is unable to offer remote work to residents of Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Hawaii, Idaho, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Montana, Nebraska, Nevada, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Washington, West Virginia, And Wyoming.
Overview Archimedes is a specialty drug management company with an industry-leading technology platform that health plans and employer groups can use to manage specialty drug spend.
We are expanding our team and looking for a professional who has specialty drug management experience and a passion for cost management.
Given our continued growth trajectory, we are looking for a person who can grow with the company.
This role will be divided into two areas: first review of prior authorization of specialty medications against clinical policies, high cost case management support functions and internal clinical process development and maintenance activities.
In addition, this role will have the opportunity to help develop the expansion of services that can be performed by pharmacy technicians.
The Pharmacy Technician is responsible for being managing their assigned work queue related to non-clinical work to support prior authorizations, benefit exclusions, formulary and therapeutic substitutions and high cost case management.
This individual will be able to successfully communicate with physicians, nurses, pharmacists and members related to outstanding documentation needed for cases, patient medication history documentation, and drug cost information related to specialty and traditional medications.
Responsibilities
Develop and deliver follow up messages to physicians and members related to prior authorization and high cost case management case documentation Manage and act as primary point of contact for all high cost management and retroactive drug utilization cases, related to coordination of outbound physician notification and inbound case documentation. Manage queues for pharmacy technician related work for prior authorization, high cost cases, claims editing and clinical policy processes Perform prior authorization case management related to administrative denial and low-clinical acuity cases as identified by clinical policies and guidelines.
Qualifications
Licensed Pharmacy Technician Benefit knowledge and experience Independent, proactive, forward-thinking, creative problem solver, results-oriented Strong attention to detail and quality Ability to work on multiple projects simultaneously under pressure with strict timelines Ability to work well in team environment Strong verbal/written communication skills 2 years managed care experience Microsoft Excel, Power Point and Word proficiency Location : Address Remote Location : Country US
