Blue Cross And Blue Shield Association Rancho Cordova , CA 95741
Posted 6 days ago
Your Role
The UMRx Prior Authorization Technician team is primarily responsible for ensuring accurate and timely review of IV and injectable medications under the medical benefit, using Blue Shield of California Pharmacy and Therapeutics (P&T) Committee medication polices. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will provide support for staff pharmacists using operational expertise to prepare medication cases for clinical review outside of technician EOA. This role will also ensure compliance with various regulatory and quality accreditation requirements around drug utilization management.
Your Work
In this role, you will:
Utilize medication policy and operational principles to make authorization determination on drug case reviews within technician extension of authority
Research and collect pertinent patient and drug information to assist the pharmacists in case specific reviews and drug evaluations
Ensure coverage determinations are completed within regulatory turnaround times for all lines of business
Work in team environment to manage technician queues
Demonstrate ability to maintain individual work queue
Communicate with the physicians, physician's office staff, and pharmacies to assist with case resolution
Demonstrate ability to communicate well with other team members and help to create team synergies
Participate in, evaluate and maintain efficient workflow procedures
Perform additional activities as assigned and discussed with manager, including participation in all workstreams within UMRx, including but not limited to, intake, system testing, and Peer to Peer
Work a weekend and holiday rotation schedule
Perform other duties as assigned by the Management Team
Blue Cross And Blue Shield Association