Location: Fully remote. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
Shift:
Monday - Friday, 11:00am - 8:00pm Eastern Standard Time
Weekend rotation every 5-6 weeks; 4-hour shifts on Saturday and Sunday
Build the Possibilities. Make an Extraordinary Impact.
The Pharmacy Technician II is responsible for the interpretation and data entry of moderately to complex clinical information, processing prior authorizations, and troubleshooting adjudication issues.
How you will make an impact:
Primary duties may include but not limited to:
Educates members on pharmacy-based rules related to prescriptions.
Verifies member information and inputs data.
Process prior authorization requests from physician offices and ensures compliance with Commercial, Medicare and Medicaid requirements.
Provides resolution to grievances and appeals issues.
Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.
Informs relevant parties of all prior authorization determinations.
Contacts physician offices to obtain additional information needed for prior authorization reviews.
Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports.
Minimum Qualifications:
Requires an active, professional license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.
Requires H.S. diploma or equivalent and minimum of 2 years of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Retail pharmacy experience.
Intermediate proficiency using Microsoft Office.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills and analytical skills. Associates are also expected to have a strong understanding of computer technology and knowledge of being able to navigate different databases, familiarity with Microsoft Programs.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
