Pharmacy Technician

Job Description

Pharmacy Technician Responsibilities:

1. Input, review and decision Medicare Part B and Medi-Cal requests for J codes, S code, Q codes, B codes and other medical benefits drugs/supplies.

2. Review Requests based on UM logic and criteria including but not limited to LCD, NCD, UM manual, MCG, MDX and other establish criteria when applicable.

3. Technical/Clinical review of authorizations (drug and utilization management) that includes reviewing authorization, chart notes, and/or relevant clinical information to render a clinical recommendation.

4. Decision prior authorizations within compliance turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.

5. Ensure all departmental goals (including, but not limited to turnaround, production expectations, and quality metrics) are met.

6. Ensure all company’s goals (including, but not limited to the 6 Strategic Priorities: Member Experience, Network, Team Member, Operational Excellence, Technology, and Financial Stewardship).

7. Communicate with providers (doctor and pharmacy) on issues related to the RxUM policies and procedures.

8. Interface with pharmacy benefit management (PBM) company, when necessary, in regard to adjudication and medication processing issues.

9. Assist in expedited review of discharge related orders or requests and coordination with specialty pharmacy providers (disease therapy management program), and internally with Utilization Management, Behavioral Health, or Care Management departments.

10. Assist Clinical Pharmacist in review of Member’s medication regimen and assist in care coordination internally with Utilization Management, Behavioral Health, or Care Management departments.

11. Actively participate in internal quality improvement process enhancements, LEAN projects, and managing for daily improvement (MDI).

12. Participate in various pharmacy projects to meet the standards of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Projects included, but not limited to, pharmacy utilization management review, provider and pharmacy outreach, formulary alternative conversion and discharge medication transition.

13. Participate in team training and professional development of prior authorization processing, pharmacy claims, grievances, discharges, and any related pharmacy issues.Company Description

Cross Country Workforce Solutions Group (CCWSG) is a human resource, consulting and talent acquisition firm, specializing in PACE Programs, FQHCs/CHCs, and State Healthcare plans throughout the US. Our national operations center is located in Southern California.

CCWSG provides clinical and non-clinical staffing support to PACE centers across the country; we are the nation’s exclusive provider of non-medical, in-home caregivers for the elderly enrolled in PACE programs. Currently, we have over 3,000 caregivers supporting patients in their homes through PACE.

We are a part of the Cross Country Healthcare family, a market-leading workforce solutions, tech-enabled talent platform, and staffing, recruitment, and advisory firm with almost 40 years of industry experience and insight. We are a full-service partner, combining market expertise and services, including contingent staffing, consulting, human capital, management solutions, recruitment process outsourcing, vendor management, and direct hiring.