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 Utilization Management Pharmacy Technician is responsible for resolving complex and high-impact benefit issues involving prior authorizations, step therapy, appeals, and denied claims. This role requires deep knowledge of pharmacy benefit design, high-cost medications, and payer policies. The Utilization Management Pharmacy Technician works with the clinical pharmacist to support both members and providers by navigating challenging benefit issues and serves as a trusted internal resource for technical and policy-related guidance. This position works collaboratively across multiple teams within the health plan and system and supports all lines of business, including government-funded programs.

Key Responsibilities:

- Evaluate prior authorization requests using established clinical criteria for both medical and pharmacy benefits, ensuring timely and accurate decisions. 

- Assist in resolving medication access issues by interpreting benefits, handling exceptions, and coordinating insurance overrides. 

- Support the pharmacy appeals process by gathering documentation and collaborating with internal teams to ensure compliant outcomes. 

- Monitor and manage the pharmacy technician's CRM queue, ensuring prompt and high-quality responses. 

- Assist the Senior Utilization Management Pharmacy Technician and clinical pharmacists in implementing formulary updates and member communications following P&T Committee decisions. 

- Provide guidance to team members by serving as a resource on pharmacy operations policies and procedures. 

- Help maintain and update reference materials and training documents to reflect current clinical and regulatory standards. 

- Offer Tier 1 and Tier 2 help desk support during high-volume periods to ensure operational continuity. 

- Participate in department projects and initiatives aimed at improving workflows and member experience. 

- Other duties as assigned 

Qualifications:

•         Education: HS Diploma/GED

•         Experience: +3 years of relevant experience. 

•         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.