About the Company
Optum, a part of UnitedHealth Group, is a leading health services innovation company dedicated to helping people live healthier lives and making the health system work better for everyone. With a strong presence in managed care, Optum leverages data, technology, and clinical expertise to improve patient outcomes, reduce costs, and enhance the overall healthcare experience. Our Nashville office is a vital hub for our managed care operations, supporting a nationwide network of providers and members.
Job Description
We are seeking a dedicated and detail-oriented Managed Care Pharmacy Technician to join our team in Nashville, TN. This office-based position plays a critical role in ensuring the efficient and accurate processing of prescription claims, prior authorizations, and member benefit inquiries within a managed care environment. You will work closely with pharmacists, healthcare providers, and members to facilitate appropriate medication utilization and adherence to plan formularies and guidelines. This role offers excellent benefits and a supportive work environment where your contributions directly impact patient care and operational efficiency.
Key Responsibilities
- Process prescription prior authorization requests, ensuring compliance with plan criteria and clinical guidelines.
- Communicate with prescribers' offices to obtain necessary clinical information and clarify prescription details.
- Resolve pharmacy-related inquiries from members, providers, and internal staff regarding benefits, formulary issues, and claims.
- Assist pharmacists in reviewing and approving medication requests based on established protocols.
- Maintain accurate and confidential patient records and prescription information.
- Participate in quality improvement initiatives and adhere to all regulatory requirements (e.g., HIPAA).
- Perform data entry and manage administrative tasks related to pharmacy operations.
- Collaborate with interdisciplinary teams to optimize patient outcomes and managed care processes.
Required Skills
- Certified Pharmacy Technician (CPhT) status from PTCB or NHA.
- Minimum of 2 years of experience as a Pharmacy Technician, preferably in a managed care, retail, or hospital setting.
- Proficiency in pharmacy software systems and Microsoft Office Suite.
- Strong verbal and written communication skills.
- Excellent attention to detail and organizational abilities.
- Ability to work independently and as part of a team in a fast-paced office environment.
- Solid understanding of medical terminology, drug names, and dosage forms.
Preferred Qualifications
- Associate's or Bachelor's degree in a related field.
- Experience with specific managed care pharmacy platforms (e.g., RxClaim, HealthRules).
- Knowledge of health plan formularies, prior authorization processes, and appeals procedures.
- Experience with sterile compounding or IV admixture.
Perks & Benefits
- Comprehensive health, dental, and vision insurance plans.
- 401(k) retirement plan with company match.
- Paid time off (PTO) and company-paid holidays.
- Life insurance and disability coverage.
- Tuition reimbursement and professional development opportunities.
- Employee assistance program (EAP).
- Wellness programs and resources.
- On-site fitness center (at select locations) and employee discounts.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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