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Pharmacy Technician III- Escalations





Pharmacy Technician III- Escalations (Pharmacy Tech III Dispensing)

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles within our Mason, OH, Grand Prairie, TX, Chandler, AZ, or Tucson, AZ, PulsePoint locations.

CarelonRx Pharmacy is now part of CarelonRx (formerly IngenioRx), a proud member of the Elevance Health family of companies. The CarelonRx Home Delivery Pharmacy will deliver digital first pharmacy experience that is convenient, simpler to use, and more affordable to patients and payers. Our Pharmacy model focuses on whole person care, providing the best member experience to drive adherence, affordability, and improved overall health outcomes by putting the patient first.

The Pharmacy Technician III- Escalations will perform all pharmacy technician duties under the regulatory authority of the state they are practicing in and aid in the dispensing of prescriptions to patients by the CarelonRx Pharmacist. Responsible for complex pharmacy, patient, and prescriber encounters, including, but not limited to prescription claim adjudication exceptions, returns, reships, drug recalls, and patient and prescriber escalations.

How you will make an impact:

  • Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs.
  • Serves as the subject matter expert, proactively manages service failures and workflow in our contact center tool and our prescription processing system.
  • Partner and support pharmacists in the performance of their duties, including outreach to patients and prescribers for resolution on open issues.
  • Processes prior authorization requests from physicians and ensures compliance with all regulatory requirements; informs relevant parties of all prior authorization determinations.
  • Provides resolution to grievances and appeals issues.
  • Managing inbound and outbound communications, triaging and problem-solving pharmacy inquiries, ensuring any related patient and prescriber communication is completed and resolving all related open cases across patient services tool and pharmacy processing system, and managing prescription queue workflow.
  • Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.
  • Generates reports relating to rebates, physician utilization, Beers Criteria, Reliance members, and other ad hoc reports.
  • Mentor and train lower-level pharmacy technicians as needed; as well as lead pharmacy technicians working prescription queue-based assignments to ensure quality, meeting turnaround times, and delivering on patient, prescriber, and client experience and expectations.
  • Collaborates with account management and client facing partners to resolve Escalations that occur in the normal operations of the Pharmacy. This may include working with patients, providers, and internal business partners to ensure Client and Patient issues are resolved.

Minimum Requirements:

  • Requires H.S. diploma or equivalent and minimum of 5 years of pharmacy experience.
  • Requires an active, professional license, if required by state law(s), State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.
  • Experience with PBM/Plan insurance setup and processing and claims adjudication and resolution of reject messaging required.

Preferred Skills, Capabilities, and Experiences:

  • Experience with EnterpriseRx, Patient Services Tool, and COS preferred.

For URAC accredited areas, the following professional competencies strongly preferred: strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.


Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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