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Job Posting Title

Clinical Operations Technician

Job Description

The Associate Clinical Operations Technician is responsible for processing, communicating, documenting and tracking requests for formulary exceptions, prior authorizations, quantity exceptions, and brand override for delegated utilization management (UM) products and services.

Responsibilities

• Review criteria to determine if the request can be approved and accurately enter Prior Authorizations in claims system to ensure appropriate claims will adjudicate

• Respond to completed requests by creating written communication of the clinical outcome to the member and the member’s physician within client specific turnaround times

• Research and respond to calls and emails

• Perform outreach calls to pharmacies and physician’s offices related to the department process across multiple clients to obtain all necessary information related to UM requests, including occasional member assistance

• Provide all relevant clinical information specific to a UM request to a department Pharmacist and the Physician

• Manage work queue and volumes to meet client specific turnaround times

• Commercial: Responsible to be proficient in one area (i.e., intake, research, etc.); area assignment is based on department need

• Government Programs: Responsible to be proficient in single review, approval/denial, etc.

• Other duties as assigned

Minimum Qualifications

• High school diploma from an accredited school or equivalent GED

• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Availability to work overtime, weekends and holidays on a rotating basis as needed

• Ability to work a flexible schedule to accommodate business needs

• Strong verbal and written communication skills, interpersonal skills, and attention to detail

• Demonstrated organizational and time-management skills

• Willingness and ability to learn internal systems/processes/programs as needed

• Basic math skills and general PC knowledge including Microsoft Office, Internet, and email

Preferred Qualifications

• Associate’s degree in business or related area of study, or equivalent combination of education and/or relevant work experience

• National Pharmacy Technician Certification through PTCB or ExCPT (CPhT)

• PBM/health care experience

Minimum Physical Job Requirements

• Constantly required to sit, use hands to handle or feel, talk and hear

• Frequently required to reach with hands and arms

• Occasionally required to stand, walk and stoop, kneel, and crouch

• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to Supervisor in the Clinical Review department

Potential pay for this position ranges from $18.85 - $24.42 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.