St. Luke's Health System

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

Overview

The Senior Utilization Management Pharmacy Technician is a key resource for resolving complex pharmacy benefit issues, including prior authorizations, step therapy, appeals, overrides, and denied claims. This role requires advanced knowledge of pharmacy benefit design, high-cost medications, and payer policies. It provides operational oversight, mentorship, and subject matter expertise while collaborating across multiple teams within the health plan and St. Luke’s system. The position supports all lines of business, including government-funded programs, ensuring compliance, cost containment, and timely access to medications. This role serves as a subject matter expert and/or team leader, providing advanced problem-solving, mentorship, and operational oversight.

Key Responsibilities:

 - Lead the evaluation of complex prior authorization requests by applying clinical criteria across both medical and pharmacy benefits, ensuring timely and compliant decision-making. 

- Serve as a liaison for resolving high-impact medication access challenges, including benefit interpretation, exception handling, and insurance override coordination. 

- Oversee the appeals process for pharmacy-related decisions, collaborating with clinical teams and regulatory partners to ensure accurate and compliant outcomes. 

- As needed, serve as the team lead. This includes training and mentoring new staff members by delivering onboarding programs, facilitating skill-based training, and providing ongoing guidance. 

- Manage the pharmacy technician CRM queue, ensuring timely, high-quality responses and continuous workflow improvements. 

- Partner with clinical pharmacists to implement formulary changes and coordinate member communications following Pharmacy & Therapeutics (P&T) Committee decisions. 

- Act as a Subject Matter Expert (SME) across multiple lines of business, providing real-time guidance and mentorship to pharmacy operations staff and other departments. 

- Maintain and develop educational and reference materials for pharmacy clinical operations, ensuring alignment with current clinical policies and regulatory standards. 

- Provide Tier 1/2 help desk support during peak volume periods, demonstrating flexibility and commitment to operational excellence. 

- Contribute to strategic initiatives and special projects as assigned, supporting continuous improvement and innovation within pharmacy operations. 

- Other duties as assigned 

Qualifications

•         Education: HS Diploma/GED

•         Experience: +4 years 

•         Licenses/Certifications: Valid Idaho Pharmacy Technician license.

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.