Aetna Pharmacy Technician I, II, III in Phoenix, Arizona
Req ID: 47110BR
Supports comprehensive coordination of Medicare pharmacy services including intake and processing of pharmacy coverage determinations requests. Promotes and supports quality effectiveness of Healthcare and Pharmacy Services. Evaluates, authorizes approval, and communicates decisions for pharmacy coverage determination requests according to clinical guidelines.
-High Volume call center and production unit.
-Evaluates and authorizes approval of pharmacy coverage determination requests from prescribers received by telephone and/or facsimile using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physicians office staff, medical management staff, members, and/or pharmacists.
-May perform clinical research to support coverage determination request.
-Utilizes various propriety systems to build, research, process and enter coverage determinations.
-Performs non-medical research including eligibility verification, COB, and benefits verification.
-Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
-Escalates requests to Pharmacist when request requires extensive clinical review or denial.
-Promotes communication, both internally and externally to enhance effectiveness of medication therapy management services.
-Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
-May communicate with Aetna Case Managers and Health Plan Staff.
-Process requests in compliance with various laws and CMS regulations and company policies and procedures.
-Sedentary work involving significant periods of sitting, talking, hearing, and keying.
-Work requires visual acuity to perform close inspection of written and computer generated documents as well as dual PC monitors.
Experience in retail, hospital, facility or call center is preferred.
Proficiency in computerized pharmacy systems and software applications.
Excellent verbal and written communication skills.
Experience with Windows-based software applications.
High School Diploma or G.E.D.
A current Pharmacy Technician certification with the National Board of Pharmacy (PTCB) and AZ State License is required.
The lowest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
LICENSES AND CERTIFICATIONS
Pharmacy/Pharmacy Technician is required
PTCB is required
Functional - Customer Service/Customer Service - Pharmacy/1-3 Years
Functional - Clinical / Medical/Precertification/1-3 Years
Technical - Computer Operations/System and Console Operations/1-3 Years/
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care