Pharmacy Technician

**PHARMACY TECHNICIAN** **Location:** **REMOTE** **Employment Type:** **Full\-Time, NON\-EXEMPT** **Schedule:** **Monday–Friday, 8:00 a.m.–5:00 p.m.** **Hourly Range:** **$23\.67\- $27\.22** **ABOUT UMPQUA HEALTH** At Umpqua Health, we’re more than a healthcare organization—we’re a community\-driven Coordinated Care Organization (CCO) dedicated to improving the health and well\-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole\-person care through primary care, specialty care, behavioral health services, and care coordination. **POSITION PURPOSE** The Pharmacy Technician supports medical management functions, including utilization management, pharmacy management, and care coordination, by applying knowledge within assigned areas. This role ensures compliance with Umpqua Health Alliance policies and procedures, clinical practice guidelines, and applicable state and federal regulations. The Pharmacy Technician serves as a liaison between Oregon Health Plan members, providers, pharmacies, and community healthcare partners to support effective communication and coordination of care. Working under general supervision, this position performs standard clinical review and medical management support tasks to ensure accurate, timely, and compliant processing of pharmacy\-related services.**ESSENTIAL JOB RESPONSIBILITIES****Regulatory Compliance:*** Maintains knowledge of Oregon Administrative Rules (Medicaid) governing coverage determinations. * Complies with organizational policies and procedures, Code of Conduct, Compliance Plan, and all applicable federal, state, and local regulations. **Utilization Review:*** Performs initial reviews of pharmacy and medical service coverage requests and documents timely, accurate determinations. * Applies Health Evidence Review Commission Prioritized List of Health Services in coverage decisions. * Follows utilization management guidelines and meets inter\-rater reliability (IRR) performance standards. * Evaluates medical necessity, cost, effectiveness, and appropriateness of services using claims data and clinical information. * Prepares cases for pharmacist review, including documentation of findings, benefit determinations, coding verification, supporting citations, care plans, risk assessments, and alternative treatment options. * Communicates with provider regarding formulary options, prior authorizations, step therapy requirements, and applicable coverage criteria. * Perform accurate data entry into claims adjudication systems. **Care Coordination:*** Supports Medication Management program activities, including outreach to members, pharmacies, and providers for Med Synch and scheduling coordination. * Assists in resolving barriers to medication access and coordinating services across departments. * Educates members and providers on health plan benefits, rights, and responsibilities. * Collaborates with the Grievance and Appeals Coordinator regardi