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Central Prior Authorization Pharmacy Technician
The Christ Hospital Health Network
Ohio, USA
Junior · 2+ years experience
Onsite
Discovered 2 weeks ago
Full Job Posting
Qualifications
- EDUCATION: High school diploma or GED required.
- YEARS OF EXPERIENCE: A minimum of 2 years of pharmacy technician experience required. Retail pharmacy or ambulatory care experience preferred.
- REQUIRED SKILLS AND KNOWLEDGE:
- Must meet all minimum qualifications for a Central PA Pharmacy Technician I
- A work history of qualitative consistency, productivity and appropriate independence.
- A work history of initiative, motivation and flexibility.
- A work history of above average quality, quantity and knowledge of work.
- A work history of above average attendance and reliability.
- LICENSES REGISTRATIONS &/or CERTIFICATIONS:
- Ohio State Board of Pharmacy Technician Registration Required
- Certified Pharmacy Technician (PTCB/CPhT) certification required.
- Must keep active PTCB/CPhT certification and registration with the Ohio State Board of Pharmacy for duration of employment as a Pharmacy Technician.
Responsibilities
- Views & Evaluates PA Requests
- Analyzes PA submissions from providers to ensure they meet clinical and formulary guidelines.
- Reviews patient history, lab results, and diagnosis codes when available.
- Assesses medical necessity based on criteria such as FDA-approved indications, compendia, and internal policies.
- Applies Clinical Criteria
- Uses evidence-based guidelines (e.g., Medicare Part D, NCCN, IDSA, ADA) to determine approval or denial.
- Identifies off-label use and evaluates its appropriateness.
- Communicates with Providers
- Requests additional documentation or clarification when needed.
- Explains coverage decisions and educate on formulary alternatives or step therapy requirements.
- Documents & Processes Authorizations
- Enters decisions into pharmacy benefit management (PBM) or health plan systems.
- Ensures accurate record-keeping for compliance and audit purposes.
- Collaborates with Internal Teams
- Works with case managers, medical directors, and utilization review teams.
- Participates in interdisciplinary discussions about complex or high-cost cases.
- Monitors for Compliance & Fraud
- Identifies potential overuse, misuse, or inappropriate prescribing patterns.
- Flags questionable cases for further investigation.
- Maintains Up-to-Date Knowledge
- Stays current on formularies, new drug approvals, clinical guidelines, and payer policies.
- Attends continuing education and internal training sessions.
- Supports Appeals Process
- Prepares clinical rationales for appeal responses in conjunction with a pharmacist.
- Reviews new evidence submitted during appeal reviews.
- Provides Education
- Educates prescribers, patients, and internal staff about prior authorization processes and criteria.
- Helps reduce PA burden through proactive outreach and education on preferred alternatives.
- Quality Assurance & Process Improvement
- Participates in audits and contributes to quality improvement initiatives.
- Helps streamline workflows and improve efficiency in the PA process.
- Other Duties
- Performs Pharmacy Technician II duties and responsibilities in other areas across the network including but not limited to the retail, inpatient, and ambulatory pharmacy departments as needed.
- As a representative of The Christ Hospital Health Network and Department of Pharmacy Services, promotes a positive image in all dealings with all other hospital associates and hospital customers.
- Performs other duties as deemed necessary by the Director of Pharmacy, Assistant Director, and pharmacists.
About The Christ Hospital Health Network
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