vacancy remote job Pharmacy Technician – Health Plan – Remote ID-1124

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American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

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Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleDoc 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts with company match
Employee Referral Bonus Program

JOB SUMMARY:

The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan’s Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).

ESSENTIAL JOB DUTIES:

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.

Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting
Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing
Effectively work with the PBM management team to effectively ascertain the highest level of Pharmacy Benefit Manager performance
Recognize formulary requirements: prior authorization (PA, Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes
Communicate with pharmacies, nursing homes, and providers
Coordinate clinical reporting
Follow-up and solve open items in a timely manner
May be assigned to work on special projects and business initiatives
Other duties as assigned

JOB REQUIREMENTS:

Proficient with Microsoft Suite applications
Ability to navigate multiple systems
Strong analytical skills
Proficient communication and presentation skills
Adhere to Centers of Medicare and Medicaid Services (CMS) regulations and compliance requirements
Successful completion of required training

REQUIRED QUALIFICATIONS:

Education:

High school diploma or equivalent

Experience:

Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience
Experience in planning and implementation

License/Certification(s):

Pharmacy Technician certification preferred

Pharmacy Technician – Health Plan – Remote ID-1125

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