Clinical Operations Technician

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Clinical Operations Technician

**Job Description**:
The Clinical Operations Technician is responsible for processing, communicating, documenting and tracking requests for formulary exceptions, prior authorizations, and 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
- 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 multiple areas (i.e., intake, research, etc.); area assignments are based on department need
- Government Programs: Responsible to be proficient in dual reviews, compounds, etc. in addition to single review, approval/denial, etc.
- Other duties as assigned

Minimum Qualifications
- High school diploma from an accredited school or equivalent GED
- 6 months of pharmacy experience or health care delivery experience
- Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications
- 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
- Willingness to work a flexible schedule to accommodate business needs including weekend shifts and holidays
- Ability to adapt and work collaboratively in a dynamic fast-paced production environment

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)
- 1 year of PBM experience
- Ability to work independently
- Demonstrated proficiency in the use of RxClaim and all necessary resources
- Demonstrated ability to handle multiple clients without jeopardizing quality, accuracy, or timely completion of requests

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 $18.46 - $23.94 based on location, experience and skills.

- To review our Benefits, Incentives and Additional Compensation, visit our

- Benefits Page

- and click on the "Benefits at a glance" button for more detail.