Aetna Senior Pharmacy Technician (Valid Certification Required) in Houston, Texas
Req ID: 67660BR
Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. Promotes and supports quality effectiveness of healthcare and Pharmacy Services. Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
Fundamental Components included but are not limited to:
High volume call center and production unit.
Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physician s office staff, medical management staff, members, and/or pharmacists.
May perform clinical research to support request
Utilizes various proprietary systems to build, research, process and enter requests.
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.
Qualifications Requirements and Preferences:
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.
National Pharmacy Technician certification and Texas State License, current and in good standing, are required.
Pharmacy - Pharmacy Technician
Clinical / Medical - Precertification, Customer Service - Customer Service - Pharmacy
Computer Operation - System and Console Operations
Benefit eligibility may vary by position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.