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 Operations TechnicianJob 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 established criteria to determine approval eligibility and accurately enter prior authorizations into the claims system to ensure appropriate claim adjudication
• Prepare and deliver written and verbal notifications of clinical outcomes to members and their physicians in response to completed UM requests, ensuring compliance with client-specific turnaround times
• Research and respond to incoming calls and emails, providing accurate information and resolution in accordance with departmental processes, quality standards, and service expectations
• Conduct outreach to pharmacies and physician offices across multiple clients to obtain required information for UM requests, including occasional assistance to members
• Manage assigned work queues and volumes to meet client-specific turnaround time, productivity, and accuracy standards
• 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 the need for work visa or residency sponsorship

Additional Qualifications

• Strong verbal and written communication skills, interpersonal skills, and attention to detail
• Demonstrated organizational and time-management skills with the ability to work independently
• Ability 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
• Basic math skills and general PC knowledge including Microsoft Office, Internet, and email
• 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

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

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 $17.85 - $25.48 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 (https://www.primetherapeutics.com/benefits).

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.