Pharmacy Technician - Health Plan - Remote

Remote, USA Full-time Posted 2025-03-12

You must reside in one of the following states for this position:
AL, AR, AZ, FL, GA, IA, ID, IL, IN, KS, KY, LA MI, MO, MS, NC, NY, OH, OK, PA, SC, TN, TX, UT, WI
...
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:
? 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:

o High school diploma or equivalent

? Experience:

o Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience

o Experience in planning and implementation

? License/Certification(s):

o Pharmacy Technician certification preferred

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

This employer participates in E-Verify

Apply Job!

Similar Remote Jobs

Pharmacy Technician - Health Plan - Remote

Posted on: 11-11-2024 03:51

New Entry-Level Remote Typing Jobs For Teens

Posted on: 11-11-2024 03:51

Call Center Representative - Remote | WFH

Posted on: 11-11-2024 03:51

Amazon Flex Delivery Driver - Earn /hr

Posted on: 11-11-2024 03:51

National Sales Manager - Wine & Spirits

Posted on: 11-11-2024 03:51

Technician, Operations- 3rd shift

Posted on: 16-07-2024 19:02

Dir-Customer Service Excellence - (Hybrid)

Posted on: 06-11-2024 04:54

Are you looking for a flexible work-from-home opportunity? Join our team as a Home-Based Data Entry Specialist! This entry-level position is perfect for individuals who are organized, detail-oriented, and eager to contribute to a growing company?all from the comfort of your home. Responsibilities: Input and update data into company systems with high accuracy. Review and verify data for completeness and consistency. Organize and maintain digital records and files. Collaborate with team members to ensure deadlines are met. Perform quality control checks to ensure data integrity. Qualifications: High school diploma or equivalent (required); additional education is a plus. Strong typing skills (minimum 40 WPM) with attention to detail. Familiarity with Microsoft Office Suite (Excel, Word) and basic computer literacy. Ability to manage time effectively and meet deadlines. A reliable internet connection and personal computer. What We Offer: Competitive hourly pay with opportunities for bonuses. Flexible work hours?choose when you work. Comprehensive training and ongoing support. Opportunities for growth within the company. Work-life balance in a supportive remote work environment. Who Should Apply: This role is ideal for students, stay-at-home parents, or anyone looking to enter the workforce or make a career change. No prior experience? No problem?we provide training for the right candidates! How to Apply: Submit your application, including your resume and a brief cover letter, to [Email Address]. Applications are reviewed on a rolling basis, so apply early! Start your remote career with us today and make an impact?right from home!

Posted on: 23-01-2025 00:00

System Analyst

Posted on: 16-07-2024 18:47

Mail Processing Associate

Posted on: 31-01-2025 09:57

Online Order Filling Team Associate

Posted on: 05-01-2025 17:57

Art Processing Clerk - 1123665300-3597

Posted on: 18-09-2024 00:00

Intern I Solutions Specialist (Remote)

Posted on: 16-07-2024 18:50