临床药学技术员 高级 - MCO 临床联络 - 远程
Clinical Pharmacy Technician Sr. - MCO Clinical Liaison - Remote
在Prime Therapeutics（Prime），我们是一家与众不同的药品福利管理公司，我们的目标超越利润，拥有独特的连接关怀的能力，为所服务的人提供支持。寻找一个有使命感的职业？与我们一同打造药房的未来。
职位发布标题
临床药学技术员高级 - MCO临床联络员 - 远程职位描述
高级临床药学技术员协助处理与纽约州医疗补助计划成员药保相关的复杂护理协调工作。工作内容可能包括索赔提交、覆盖参数和/或事先授权请求。还可能需要进行额外的推广工作，以向医务人员介绍NYRx，即医疗补助药房计划。
职责
- 评估并处理事先授权（PA）请求，包括确定药物的适当性，应用临床标准，并将决定通知医务人员、药房和内部利益相关者。
- 研究、解决并记录PA结果和复杂的医务人员/成员咨询，同时确保准确性和符合系统及文档标准。
- 领导纽约州医疗补助计划成员的复杂护理协调工作，包括接收和发出医务人员的联系、索赔解决、覆盖范围澄清以及促进事先授权以支持护理连续性。
- 向医务人员提供关于处方集覆盖范围、NYRx计划要求、事先授权流程和治疗替代方案的指导和教育。
- 根据既定协议，将需要进一步临床审查或拒绝的案例上报给药剂师。
- 在满足绩效、准确性和服务级别期望的同时，提供高质量的客户服务。
最低资格要求
· 从认证学校获得高中文凭或同等学历的GED
- 2年作为药学技术员的工作经验
- 必须持有CPT/ExCPT/LPT/PTCB/RPT、药学技术员、州立药房要求的相关证书
必须具备在美国工作的资格，无需工作签证或移民担保
附加资格要求
- 对特殊注射药物、疾病状态、处方集管理技巧、医学术语和报销编码实践有深入了解
- 熟练使用药房系统、软件应用程序和Microsoft Office产品
- 出色的书面和口头沟通能力
- 能够理解和应用既定的临床标准和操作程序
- 能够识别和解决复杂问题
查看英文原文
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Clinical Pharmacy Technician Sr. - MCO Clinical Liaison - RemoteJob Description
The Senior Clinical Pharmacy Technician assists with complex care coordination as it relates to pharmacy benefits for New York Medicaid members. Efforts may include claim submission, coverage parameters, and/or prior authorization requests. Additional outreach efforts may be needed to educate providers on NYRx, the Medicaid Pharmacy Program.
Responsibilities
- Evaluate and process prior authorization (PA) requests, including determining medication appropriateness, applying clinical criteria, and communicating decisions to providers, pharmacies, and internal stakeholders.
- Research, resolve, and document PA outcomes and complex provider/member inquiries while ensuring accuracy and compliance with system and documentation standards.
- Lead complex care coordination efforts for New York Medicaid members, including inbound and outbound provider outreach, claim resolution, coverage clarification, and facilitation of prior authorizations to support continuity of care.
- Provide guidance and education to providers on formulary coverage, NYRx program requirements, prior authorization processes, and therapeutic alternatives.
- Escalate cases requiring additional clinical review or denial to a pharmacist in accordance with established protocols.
- Deliver high-quality customer service while meeting performance-, accuracy-, and service-level expectations.
Minimum Qualifications
· High school diploma from an accredited school or equivalent GED
- 2 years of work experience as a pharmacy technician
- Required CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
- Strong knowledge of specialty injectable prescription drugs, disease states, formulary management techniques, medical terminology, and reimbursement coding practices
- Proficiency in pharmacy systems, software applications, and Microsoft Office products
- Excellent written and verbal communication skills
- Ability to interpret and apply established clinical criteria and operational procedures
- Ability to identify, troubleshoot, and resolve operational issues
Preferred Qualifications
- Specialty pharmacy, retail pharmacy, reimbursement, or health plan experience
- 2+ years of Customer Service experience
- Complex care coordination experience.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job
Potential pay for this position ranges from $19.23 - $28.85 based on 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 (
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.
Originally posted on Himalayas