Remote - Pharmacy Technician:
Carmichael Consulting Group

Carmichael Consulting Group
Long Beach California

Title: Pharmacy Technician

Candidate must have PBM experience to qualify for the position


  • Acts as the final reviewer of all prior authorization requests for accuracy before member notification. Reviews member letters for appropriateness.
  • Responsible for running reports out of internal systems and preparing documents for review by supervisor and director.
  • Adheres to department's policies and procedures and completes work in a compliant manner. Prepares training materials for staff.

Essential Functions:

  • Review pharmacy technician check sheets for accuracy to ensure compliance with Medicare regulations in regards to coverage determinations, formulary exceptions and appeals.
  • Assist management with ensuring compliance of Medicare Regulations by preparing and analyzing reports.
  • Review transition reports and ensure letters are being mailed within CMS defined timelines.
  • Investigate claim issues daily based on the Daily Reject Report and report any inappropriate denials to the supervisor/director.
  • Review prior authorization requests on an as needed basis
  • Answer phone calls from members, pharmacies and providers if the call center needs assistance.
  • Develop training materials and trains new hires as required.
  • Responsible for timely and accurate completion of daily workload. Ensure departmental standards are met.
  • Assist in the development and implementation of internal processes, policies and procedures.

Location: Remote - for the office in Long Beach, CA

Job Requirements:
  • Computer literate (Microsoft office products)
  • Interpersonal Communication Skills
  • Excellent Verbal and Written communication skills
  • Organization skills
  • Problem solving skills
  • Experience and knowledge of Medicare Regulations.
  • Medical Terminology.
  • Excellent verbal and written communication skills
  • Maintain regular attendance based on agreed-upon schedule
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
  • Excel: Ability to create documents, filter data, sort, update, and create spreadsheets.

Required Education:

  • High School Diploma or equivalent Required Experience: 2+ years in Managed Care 2+ years of customer service experience.
  • Knowledge of PBM's methodologies.
  • Medicare experience Required Licensure/Certification: Certified Pharmacy Technician

Basic Qualifications