Pharmacy Technician, Utilization Management (CPhT)

ABOUT THE ROLE:

The Rightway pharmacy team is looking for a highly motivated and energetic Pharmacy Technician to join the Pharmacy Clinical Operations team.  We are looking for team members that possess high-energy, a strong work ethic, integrity, who are kind and empathetic, and who enjoy working for a collaborative, team-oriented system.

WHAT YOU'LL DO:

• Receive and review pharmacy utilization management (UM) coverage requests from providers via telephone, fax, email, or surface mail and prepares such cases for clinical review by a pharmacist and/or medical director when required
• Responsible for all preauthorization entries into applicable databases (i.e. internal claims systems, PBM pharmacy systems) to ensure swift and appropriate payment of services deemed medically necessary
• Within the context of the request, applies plan-specific benefits to each case appropriately, summarizes pertinent facts, and cites applicable internal policies and guidelines
• Engages in member and provider outreach to resolve non-clinical issues such as soliciting information needed to process a PA request, appeal initiation requests, processing errors, and fulfilling notification requirements among others 
• Support and process patient submitted Direct Member Reimbursement (DMR) claims
• Resolves non-clinical issues independently and acts as a liaison between our customer and provider-facing teams and the Pharmacy Department
• May perform other non-clinical duties as required by management and department needs
• Supports training for new team members
• Ensures regulatory and privacy standards are consistently met

Additional Opportunities To Support The Following Navigation Activities

• Serves as a direct member and provider contact for pharmacy benefit information, prior authorization requests, and navigation support.  Inquiries may be received by telephone, chat, fax, email, or written correspondence
• Fields questions from members, human resources departments, pharmacies, and providers related to mail order, benefit design, formulary coverage and cost of medication, prior authorization criteria, claims adjudication and ensures individual’s questions and issues are resolved
• Supports Clinical Pharmacist Navigators in patient and provider outreaches, including scheduling of appointments between members and pharmacists, enrollment of members into RightwayRx’s clinical programs, and other administrative tasks

WHO YOU ARE:

• Associate’s or Bachelor’s degree preferred
• 2 years’ experience in a pharmacy technician role within a PBM, hospital, retail, or managed care setting. 
• At least 1 year of experience in a utilization management role highly preferred
• Active Certified Pharmacy Technician (CPhT)
• Detail-oriented, critical thinker, empathetic, ability to dig deep in understanding an issue to get to true root cause and resolution, desire to improve a patient’s healthcare experience and provide concierge level service.
• Knowledge of prescription drug names, therapeutic classes, pharmacy claims adjudication and benefit designs/terminology, call center experience, ability to multi-task and prioritize work, ability to work independently.
• Able to work flexible hours. Our core working hours are weekdays between 8am and 8pm EST, specific evening or weekend shifts may be required in the future as Rightway grows. These hours are subject to change.

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members who will:

• Paint the back of the fence

We look for people that take pride in producing excellent work – whether or not it’s seen. We empower each employee to operate with an “ownership” mentality and trust that they will produce exceptional results.  

• Execute with empathy 

We practice compassionate empathy in every interaction. Our team is focused on humanizing the healthcare experience and treats our workplace no differently.

• Struggle once to solve twice 

We value ingenuity. We encourage our team to think about scalable solutions that will allow Rightway to execute well today and even better tomorrow.

• Compound your pennies 

We recognize that small decisions can drive outsized returns. We love when our team makes impactful, incremental advances, especially if they believe it will drive a million-dollar return.

• It’s a great day for a great day 

We remind ourselves each and every day that we’re fortunate to be changing the healthcare system for the better. We view it as a duty to perform our roles with unbounded optimism and best-in-class execution, given how lucky we are.

Rightway is a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.

Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.