At least three years of experience as a Pharmacy Technician is required.
At least two years of experience in a utilization management or managed care environment is required.
A valid California Pharmacy Technician License in good standing must be maintained throughout employment.
Experience preparing professional business correspondence is required.
Intermediate computer skills, including email, database systems, word processing, and spreadsheets, are required.
The candidate must have strong attention to detail, organization, research, and problem-solving skills.
The candidate must communicate clearly and professionally with members, providers, Medical Groups, and internal departments.
The candidate must be able to speak, read, write, and understand the primary language used in the workplace.
Responsibilities
Review prescription medication authorization requests using established protocols and criteria.
Refer clinical questions or requests outside standardized criteria to a Clinical Pharmacist for review.
Coordinate with the Pharmacy Coordinator and internal departments to ensure authorization decisions and notifications are completed accurately and within regulatory timeframes.
Prepare and send approval, authorization, and denial letters to members and providers.
Research and prepare pharmacy cases for review by Pharmacy leadership, Clinical Pharmacists, or the Chief Medical Officer.
Assist Member Services Representatives and Medical Group staff with interpreting pharmacy benefits and prior authorization criteria.
Support research and resolution of pharmacy-related appeals and grievances.
Help maintain the WHA Formulary Drug List and Pharmacy Prior Authorization criteria based on Pharmacy and Therapeutics Committee decisions.
Assist with pharmacy and Pharmacy Benefit Manager audit activities, including DMHC and NCQA accreditation reviews.
Maintain current knowledge of medications, drug classifications, pharmacy benefits, and authorization requirements.
Support administrative functions, including provider and member notifications and returned-mail processing.
Assist with developing and maintaining pharmacy policies, training materials, and desktop procedures.
Provide mentoring and training to less-experienced Pharmacy Technicians and Pharmacy Coordinators, as needed.
Help provide coverage during holidays and Friday evenings to ensure cases are completed within required regulatory timeframes.
Perform additional duties and special projects as assigned.
Desired Qualifications
Customer service or call center experience is highly desired.
Temporary Pharmacy Technician
Western Health Advantage Location: Sacramento, CA (Hybrid) Salary: $23.00–$26.00 per hour Department: Pharmacy Position Type: Temporary
"Our purpose is strong, our impact is lasting, join us on the journey" Western Health Advantage
Summary Description
Western Health Advantage (WHA) is seeking an experienced Temporary Pharmacy Technician to support pharmacy utilization management activities at the health plan level. Working closely with the Chief Pharmacy Officer, Pharmacy Manager, Medical Directors, Clinical Pharmacists, and Pharmacy Coordinator, this position helps ensure prescription medication requests are reviewed accurately, efficiently, and in accordance with regulatory requirements.
The Pharmacy Technician will review authorization requests using established protocols, coordinate member and provider notifications, assist with pharmacy benefit interpretation, and support pharmacy-related appeals and grievances. The ideal candidate is detail-oriented, knowledgeable about medications and drug classifications, and experienced in a managed care or utilization management environment.
What You’ll Do
Review prescription medication authorization requests using established protocols and criteria.
Refer clinical questions or requests falling outside standardized criteria to a Clinical Pharmacist for review.
Coordinate with the Pharmacy Coordinator and internal departments to ensure authorization decisions and notifications are completed accurately and within regulatory timeframes.
Prepare and send approval, authorization, and denial letters to members and providers.
Research and prepare pharmacy cases for review by Pharmacy leadership, Clinical Pharmacists, or the Chief Medical Officer.
Assist Member Services Representatives and Medical Group staff with interpreting pharmacy benefits and prior authorization criteria.
Support the research and resolution of pharmacy-related appeals and grievances.
Help maintain the WHA Formulary Drug List and Pharmacy Prior Authorization criteria based on Pharmacy and Therapeutics Committee decisions.
Assist with pharmacy and Pharmacy Benefit Manager audit activities, including DMHC and NCQA accreditation reviews.
Maintain current knowledge of medications, drug classifications, pharmacy benefits, and authorization requirements.
Support administrative functions, including provider and member notifications and returned-mail processing.
Assist with developing and maintaining pharmacy policies, training materials, and desktop procedures.
Provide mentoring and training to less-experienced Pharmacy Technicians and Pharmacy Coordinators, as needed.
Help provide coverage during holidays and Friday evenings to ensure cases are completed within required regulatory timeframes.
Perform additional duties and special projects as assigned.
What You’ll Bring
High school diploma or equivalent.
At least three years of experience as a Pharmacy Technician.
At least two years of experience in a utilization management or managed care environment.
A valid California Pharmacy Technician License in good standing, maintained throughout employment.
Customer service or call center experience is highly desired.
Experience preparing professional business correspondence.
Intermediate computer skills, including email, database systems, word processing, and spreadsheets.
Strong attention to detail, organization, research, and problem-solving skills.
Ability to communicate clearly and professionally with members, providers, Medical Groups, and internal departments.
Ability to speak, read, write, and understand the primary language used in the workplace.
Equal Employment Opportunity
Western Health Advantage is committed to providing equal employment opportunities to employees and applicants based on merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis protected by federal or state law.
Western Health Advantage values and supports the unique talents and strengths each employee brings to our organization. Collaborating with the best and brightest creates a dynamic and fulfilling work experience for our employees—and excellent service for our members.
Western Health Advantage is an Equal Opportunity Employer.
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