Back to Jobs

Pharmacy Technician - Health Plan - Remote

Remote, USA Full-time Posted 2025-05-22

• You must reside in Oklahoma or Tennessee for this position

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits And Perks Include
• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts with company match
• Employee Referral Bonus Program

Job Summary

The Pharmacy Technician for American Health Plans is responsible for activities related to member access in the area of claims adjudication appropriateness and operations performed by the Plan’s Pharmacy Benefit Manager for a Medicare Advantage Institutional Special Needs Plan (I-SNP).

Essential Job Duties

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation. • Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting • Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing • Effectively work with the PBM management team to effectively ascertain the highest level of Pharmacy Benefit Manager performance • Recognize formulary requirements: prior authorization (PA, Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes • Communicate with pharmacies, nursing homes, and providers • Coordinate clinical reporting • Follow-up and solve open items in a timely manner • May be assigned to work on special projects and business initiatives • Other duties as assigned

Job Requirements
• Proficient with Microsoft Suite applications
• Ability to navigate multiple systems
• Strong analytical skills
• Proficient communication and presentation skills
• Adhere to Centers of Medicare and Medicaid Services (CMS) regulations and compliance requirements
• Successful completion of required training

Required Qualifications
• Education:
• High school diploma or equivalent
• Experience:
• Minimum of 2 years as a Pharmacy technician, long term care, or health plan experience
• Experience in planning and implementation
• License/Certification(s):
• Pharmacy Technician certification preferred

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

This employer participates in E-Verify.

Apply Job!

 

Similar Jobs

1,456 Netflix Remote Jobs || Online Netflix Remote || Netflix Jobs Salary $/25 Hour

Remote, USA Full-time

Scrum Master - Remote

Remote, USA Full-time

Print & Mail Sales Rep. ( Remote )

Remote, USA Full-time

Primarily Remote Executive/Personal Assistant to CEO/Founder of Psychotherapy Practice (LOCAL ONLY)

Remote, USA Full-time

Marketing Strategy Specialist (Disney Entertainment Television)

Remote, USA Full-time

Data Entry Specialist - Remote

Remote, USA Full-time

Data Entry Specialist - Remote

Remote, USA Full-time

Investor Support Specialist /Remote/ Part-Time/ Flexible Schedule/ 1099/

Remote, USA Full-time

Product Designer - All Levels

Remote, USA Full-time

Walmart Work From Home Obs $35/Hour

Remote, USA Full-time

Security Operations Analyst

Remote, USA Full-time

Travel Nurse RN ER - $1,859/wk in Watonga, OK

Remote, USA Full-time

Want Residential Group Home CBRF Manager (RM) - Located in Brookfield, WI in New Berlin, WI

Remote, USA Full-time

Program Manager, Operations- Permission Slip

Remote, USA Full-time

Development Specialist for Constituent Relations, College of Fine Arts

Remote, USA Full-time

SEPHORA - REMOTE 1099 SPANISH BILINGUAL CSR - CHAT/VOICE / $18/hr - Start 9/20 - #MSP

Remote, USA Full-time

Sr. Manager Software Engineering

Remote, USA Full-time

UPS Customer Success Remote Job – Remote Work – Hire Me Remotely

Remote, USA Full-time

American Airlines Customer Support Representative (Work At Home) - Job Vacancy

Remote, USA Full-time

[Fully Remote] Amazon Looking To Fill 250 Work-From-Home Jobs

Remote, USA Full-time