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Join a Visionary Team Transforming Senior Care
American Health Plans, a dynamic division of American Health Partners Inc., is on a mission to redefine the way seniors receive pharmacy services in long‑term care settings. Our Medicare Advantage Institutional Special Needs Plans (I‑SNPs) combine cutting‑edge clinical expertise with compassionate, person‑centered care to keep residents healthy, reduce unnecessary emergency department visits, and improve overall quality of life. With a footprint that currently spans Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana—and ambitious expansion plans for 2025—we are looking for a motivated, detail‑oriented Pharmacy Technician to help us deliver on this promise.
Why This Role Is a Game‑Changer
As a Remote Pharmacy Technician – Health Plan Specialist, you will be at the heart of our pharmacy benefit management (PBM) operations. You’ll blend analytical rigor with frontline communication, ensuring that every medication claim, prior authorization, and formulary request is processed accurately, efficiently, and in full compliance with Centers for Medicare & Medicaid Services (CMS) regulations. This is more than a job—it’s an opportunity to make a tangible difference in the health outcomes of vulnerable seniors while advancing your career within a forward‑thinking organization.
Core Responsibilities
In this hybrid position—combining remote work with occasional on‑site collaboration in our state‑based offices—you will be entrusted with a wide array of responsibilities designed to keep our pharmacy services running smoothly:
- Daily Claim Review & Resolution: Examine point‑of‑service (POS) pharmacy claims, identify actionable items, correct discrepancies, and generate detailed reports for senior management.
- Eligibility Coordination: Serve as a critical liaison with the Enrollment Department to verify member eligibility and ensure that only qualified participants receive pharmacy benefits.
- PBM Performance Optimization: Partner with the PBM management team to monitor key performance indicators, troubleshoot system issues, and implement process improvements that elevate service quality.
- Formulary Management: Apply deep knowledge of prior authorization (PA), step therapy (ST), quantity limits (QL), and NCPDP reject codes to facilitate appropriate medication access while adhering to formulary guidelines.
- Stakeholder Communication: Maintain clear, professional communication channels with pharmacies, nursing homes, and healthcare providers to resolve inquiries, convey policy updates, and foster collaborative relationships.
- Clinical Reporting Coordination: Assemble and deliver accurate clinical data for internal audits, regulatory submissions, and quality improvement initiatives.
- Timely Issue Follow‑Up: Track open items, prioritize based on impact, and close out tickets promptly to maintain uninterrupted pharmacy services.
- Special Projects & Initiatives: Participate in cross‑functional teams tackling strategic business projects, such as system migrations, workflow redesigns, and new state rollouts.
- Continuous Learning & Compliance: Complete required training modules, stay current on CMS regulations, and proactively suggest compliance enhancements.
Essential Qualifications
We are seeking candidates who meet the following baseline requirements:
- Education: High school diploma or equivalent; additional coursework in pharmacy, health informatics, or related fields is a plus.
- Experience: Minimum two (2) years of experience as a Pharmacy Technician, preferably within long‑term care, health‑plan environments, or PBM settings.
- Technical Proficiency: Strong command of Microsoft Office Suite (Excel, Word, Outlook) and the ability to navigate multiple pharmacy and claims‑processing systems simultaneously.
- Analytical Acumen: Demonstrated ability to interpret data, spot trends, and recommend actionable solutions.
- Communication Skills: Excellent written and verbal communication, with the capacity to present complex information clearly to diverse audiences.
- Regulatory Knowledge: Familiarity with CMS regulations, Medicare Advantage guidelines, and NCPDP standards.
- Certification: Pharmacy Technician certification (CPhT) is preferred but not mandatory.
Preferred Qualifications & Desired Attributes
- Experience working in a Medicare Advantage I‑SNP or similar specialty health‑plan environment.
- Advanced knowledge of formulary management tools and prior‑authorization workflows.
- Proven track record of driving process improvements that reduce claim turnaround time.
- Ability to work independently in a remote setting while staying aligned with team goals.
- Strong organizational skills with a focus on meticulous documentation.
- A genuine passion for improving senior health outcomes and a commitment to patient‑first thinking.
Key Skills & Competencies for Success
- Attention to Detail: Precision in claim adjudication and data entry to avoid costly errors.
- Problem‑Solving Mindset: Ability to diagnose issues quickly and implement effective resolutions.
- Time Management: Prioritize multiple tasks and meet tight deadlines without sacrificing quality.
- Team Collaboration: Work cohesively with enrollment, PBM, clinical, and provider teams across different time zones.
- Customer Service Orientation: Provide courteous, empathetic support to pharmacies, nursing staff, and members.
- Technology Adaptability: Comfort with adopting new software platforms, data analytics tools, and digital communication channels.
Work Environment & Culture
American Health Plans fosters an inclusive, supportive, and growth‑focused culture. Our remote‑first philosophy empowers you to design a work‑life balance that fits your personal circumstances while staying connected to a passionate team. We value transparency, accountability, and continuous learning. Employees are encouraged to share ideas, take ownership of projects, and celebrate both individual and collective achievements.
Our hybrid model means you will spend the majority of your time working from a home office equipped with the technology you need, with periodic visits to our regional hubs for in‑person collaboration, training, and community building. This flexibility ensures you remain engaged, informed, and part of the vibrant pulse driving our mission forward.
Career Growth & Development Opportunities
We view every team member as a long‑term partner in our success. As a Pharmacy Technician with American Health Plans, you will enjoy a clear pathway for professional advancement:
- Structured Learning Programs: Access to internal training modules, industry certifications, and webinars on pharmacy benefits, compliance, and health‑plan operations.
- Mentorship & Coaching: Pairing with senior pharmacy leaders who provide guidance, performance feedback, and career‑planning support.
- Promotional Pathways: Opportunities to transition into senior technician roles, specialist positions (e.g., Prior Authorization Analyst), or supervisory capacities within the PBM division.
- Cross‑Functional Exposure: Projects that involve collaboration with clinical, actuarial, and IT teams, broadening your skill set and organizational insight.
- National Expansion: As we roll out plans in new states, you can lead or support market entry initiatives, positioning yourself as a subject‑matter expert.
Compensation, Perks & Benefits
We recognize that a competitive salary and comprehensive benefits are essential to attract top talent. While exact figures are aligned with experience and market benchmarks, all full‑time team members can expect:
- Competitive Salary commensurate with expertise and experience.
- Medical, Dental, and Vision Coverage with multiple plan options to suit your needs.
- Generous Paid Time Off (PTO) and paid holidays to support work‑life balance.
- TeleDoc 24/7/365 giving you and your family round‑the‑clock access to virtual medical care.
- Short‑ and Long‑Term Disability Plans (optional) for additional financial protection.
- Employee Assistance Program (EAP) offering counseling, wellness resources, and financial guidance.
- 401(k) Retirement Plan with company matching to help you build a secure future.
- Employee Referral Bonus to reward you for helping us grow a talented workforce.
- Professional Development Stipends for certifications, conferences, or continuing education.
Equal Opportunity & Inclusive Workplace
American Health Plans is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an environment where every individual—regardless of race, color, religion, sex, gender identity, sexual orientation, age, disability, veteran status, or any legally protected characteristic—feels valued and can thrive. Reasonable accommodations are available upon request for qualified applicants with disabilities.
Ready to Make an Impact?
If you are a proactive, detail‑oriented professional who is passionate about enhancing pharmacy services for seniors, we want to hear from you. Join a team where your expertise will directly influence patient outcomes while you enjoy the flexibility of remote work, a supportive culture, and a clear trajectory for growth.
How to Apply
To submit your application, click the link below, upload your résumé, and complete the brief questionnaire. Our recruiting team reviews applications on a rolling basis, so the sooner you apply, the sooner we can start the conversation.
Apply Now – Transform Senior Pharmacy Care
We look forward to welcoming you to the American Health Plans family and to the rewarding journey ahead!
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