Be Part of an Extraordinary Team
Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.
Build the Possibilities. Make an Extraordinary Impact.
Title: Pharmacy Technician I - Medication Access Specialist
Location(s): Mason, OH, Indianapolis, IN, Seattle, WA, Atlanta, GA, Miami, FL, Richmond, VA, Las Vegas, NV, Houston, TX
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
As a Pharmacy Technician I - Medication Access Specialist, you will be responsible for the interpretation and data entry of basic prescriptions, handling medication access issues, and troubleshooting adjudication concerns. This role emphasizes problem-solving, communication, and member advocacy.
How you will make an impact:
* Member Support: Serve as the primary contact for members experiencing medication access issues, providing empathetic and knowledgeable assistance.
* Troubleshooting and Prior Authorization: Identify and resolve barriers to medication access, including insurance pre-authorizations and formulary restrictions. Process prior authorization requests from healthcare providers to ensure compliance with Medicare requirements, and inform relevant parties of determinations.
* Collaboration: Work closely with healthcare providers, insurance companies, and pharmacies to resolve complex medication access cases.
* Education and Communication: Inform members about pharmacy-based rules, alternative medications, and resources for assistance programs. Navigate members through the appeals process when necessary.
* Documentation and Reporting: Accurately document member interactions and generate reports relating to rebates, physician utilization, and other relevant metrics. Maintain records of prior authorizations and monthly reports.
* Continuous Improvement: Suggest process enhancements to improve the member experience by identifying patterns in medication access barriers.
Minimum Requirements:
* Requires H.S. diploma or equivalent and minimum of 1 year of pharmacy experience; or any combination of education and experience, which would provide an equivalent background.
* Current State Pharmacy Tech.
* Certification or National Certification based on applicable state(s) required.
Preferred Skills/Experience/Education:
* CPhT, certified pharmacy technician strongly preferred.
* Experience with Medicaid members strongly preferred.
* Retail pharmacy experience strongly preferred.
* Strong understanding of insurance billing processes and formulary management strongly preferred.
* Problem solving skills preferred.
* Excellent verbal/written communication skills preferred.
* Ability to work independently highly preferred.
* Flexibility highly preferred.
* Compassionate approach to patient care with a strong commitment to service excellence highly preferred.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
If his job is used in Simply Healthcare or Americas First Choice, no UM approval or denial activities will be performed by the associate.
For candidates working in person or virtually in the below location(s), the hourly salary* range for this specific position is $16.92-$29.19.
Location(s): Washington, Nevada
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
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