Rightway's RightwayRx operates a pharmacy benefit management program. This role supports UM leadership and actively works utilization management cases. The position helps design, build and operate the PBM model to manage pharmacy spend for employees and dependents.
What you'll do
Support all lines of business by facilitating utilization management requests for coverage, entering authorizations into the claims platform, and coordinating member and provider communications.
Provide support to members enrolled in specialty management programs, including coordinating prior authorizations, pharmacy fulfillment with the specialty partner, enrollment in patient assistance programs, and addressing billing questions.
Coordinate with pharmacy technicians, pharmacists, and medical directors on UM activities.
Make outbound calls to provider offices to obtain clinical information missing from UM cases.
Ensure cases are reviewed in accordance with state and federal guidelines and turnaround time requirements, and participate in quality reviews and inter-rater reliability processes.
What they're looking for
1-2 years experience as a pharmacy technician in a PBM, health plan, or similar managed care setting, or 1-2 years in mail order or specialty pharmacy.
Active National Certified Pharmacy Technician (CPhT).
Detail oriented, critical thinker with empathy and the ability to dig to root causes and resolve issues.
Knowledge of pharmacy claims adjudication and benefit designs/terminology, call center experience, and the ability to multi-task and work independently.
Associate or Bachelor’s degree preferred.
For applicants in Nigeria
The listing does not state any regional hiring restrictions; this is a remote role. Please confirm during interview.
The listing does not specify a timezone requirement; confirm before interviewing.
The listing does not specify whether this is a contractor or employee role.
Compensation is listed as $22.00/hr with compensation offered determined by geographic location, experience, and qualifications.
The listing does not mention visa or work authorization requirements.
Summarized by RemoteWork from the original listing. Always confirm details on the employer’s page.
Perks & benefits
What this listing says it offers, and who each perk covers. Perks limited to US or EU employees often do not reach contractors or people hired through an employer of record, which is how many hires from Nigeria are paid.
Pays in USD
$22.00/hr
Compensation offered will be determined by geographic location, experience, and qualifications.
Not stated who it coversFrom this job listing
Ready to apply?
Your application goes straight to Rightway, on their own hiring page.