IntePros
Job Title: Pharmacy Technician – Direct Ship Team
Department:
Care Management & Coordination Location:
Remote (requires residence in PA, NJ, or DE)
Job Summary The Pharmacy Technician on the Direct Ship Team plays a critical role in ensuring timely, compliant, and medically appropriate medication access for members. This position is responsible for reviewing clinical documentation to assess medical necessity for pharmacy services using established criteria, clinical judgment, and independent analysis. The Pharmacy Technician collaborates directly with healthcare providers to obtain additional clinical information when needed and is authorized to independently approve medically necessary services, committing the organization financially when criteria are met. Cases that fall outside established guidelines are escalated to the Clinical Care Coordinator for further review. This role also ensures compliance with all applicable federal, state, and accreditation regulations while meeting productivity and turnaround time standards.
Key Responsibilities Apply advanced clinical knowledge, critical thinking, and independent judgment to evaluate medication and service requests. Review medical records, including medical history and treatment plans, to determine medical necessity using approved guidelines and resources. Utilize Care Management Policy, Medical Policy, Micromedex, and Electronic Desk References to support utilization decisions. Collaborate with prescribing and servicing providers to clarify treatment plans and obtain additional clinical information as needed. Notify ordering providers and Specialty Pharmacy vendors of authorization approvals and coordinate medication shipment to provider offices. Review and validate treatment plans for requested medications, ensuring clarity and completeness of clinical information. Identify cases that do not meet medical necessity criteria and refer them to the Clinical Care Coordinator for further evaluation. Confirm that all approved services align with the member’s benefit plan. Ensure utilization decisions comply with state, federal, and accreditation regulations. Meet or exceed regulatory turnaround times and departmental productivity benchmarks. Accurately document all determinations and actions in accordance with Care Management & Coordination policies. Maintain data integrity through timely and precise system documentation. Perform additional duties as assigned.
Qualifications & Requirements Certified Pharmacy Technician (CPhT)
– required Minimum of
2 years of experience
preferred in Utilization Review, Utilization Management, or a related clinical or pharmacy setting Strong knowledge of medical necessity criteria and clinical documentation review Excellent communication skills with the ability to interact professionally with providers and internal clinical teams High attention to detail and ability to work independently in a remote environment
Care Management & Coordination Location:
Remote (requires residence in PA, NJ, or DE)
Job Summary The Pharmacy Technician on the Direct Ship Team plays a critical role in ensuring timely, compliant, and medically appropriate medication access for members. This position is responsible for reviewing clinical documentation to assess medical necessity for pharmacy services using established criteria, clinical judgment, and independent analysis. The Pharmacy Technician collaborates directly with healthcare providers to obtain additional clinical information when needed and is authorized to independently approve medically necessary services, committing the organization financially when criteria are met. Cases that fall outside established guidelines are escalated to the Clinical Care Coordinator for further review. This role also ensures compliance with all applicable federal, state, and accreditation regulations while meeting productivity and turnaround time standards.
Key Responsibilities Apply advanced clinical knowledge, critical thinking, and independent judgment to evaluate medication and service requests. Review medical records, including medical history and treatment plans, to determine medical necessity using approved guidelines and resources. Utilize Care Management Policy, Medical Policy, Micromedex, and Electronic Desk References to support utilization decisions. Collaborate with prescribing and servicing providers to clarify treatment plans and obtain additional clinical information as needed. Notify ordering providers and Specialty Pharmacy vendors of authorization approvals and coordinate medication shipment to provider offices. Review and validate treatment plans for requested medications, ensuring clarity and completeness of clinical information. Identify cases that do not meet medical necessity criteria and refer them to the Clinical Care Coordinator for further evaluation. Confirm that all approved services align with the member’s benefit plan. Ensure utilization decisions comply with state, federal, and accreditation regulations. Meet or exceed regulatory turnaround times and departmental productivity benchmarks. Accurately document all determinations and actions in accordance with Care Management & Coordination policies. Maintain data integrity through timely and precise system documentation. Perform additional duties as assigned.
Qualifications & Requirements Certified Pharmacy Technician (CPhT)
– required Minimum of
2 years of experience
preferred in Utilization Review, Utilization Management, or a related clinical or pharmacy setting Strong knowledge of medical necessity criteria and clinical documentation review Excellent communication skills with the ability to interact professionally with providers and internal clinical teams High attention to detail and ability to work independently in a remote environment