Pharmacy Technician, Retrospective Case Management

Navitus Health Solutions

. Manage assigned work queues related to non-clinical retrospective case management operations, benefit exclusions, formulary and therapeutic substitutions, and high-cost case management .

Posted 10/21/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in non-clinical retrospective case management operations, including benefit exclusions and high-cost case management. Proficient in coordinating communication between healthcare professionals and managing documentation effectively.

Highest-signal resume keywords

Licensed Pharmacy TechnicianRetrospective Case ManagementBenefit KnowledgeMicrosoft Excel ProficiencyPharmacy Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Retrospective Case ManagementBenefit KnowledgeHigh-Cost Case ManagementCase Documentation ManagementProvider Denial Management

Soft Skills

Cooperative InteractionRespectful Communication

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointMicrosoft Word

Certifications & Qualifications

Licensed Pharmacy Technician

Industry Keywords

PharmacyHospitalManaged CareCompliance ProgramClinical Policies

About the role

Key responsibilities & impact

Manage assigned work queues related to non-clinical retrospective case management operations, benefit exclusions, formulary and therapeutic substitutions, and high-cost case management
Communicate with physicians, nurses, and pharmacists regarding outstanding case documentation, patient medication histories, and specialty/traditional medication cost information
Perform first reviews of retrospective case management for specialty medications against policies
Support high-cost case management functions
Participate in internal clinical process development and maintenance activities
Help develop expanded services that can be performed by pharmacy technicians
Develop and deliver follow-up messages to physicians regarding case management documentation
Organize peer-to-peer collaboration between physicians and pharmacists
Serve as primary point of contact for high-cost case management and retroactive drug utilization cases
Coordinate outbound physician notifications and inbound case documentation
Manage queues and organize documents for pharmacy technician case management work
Perform retrospective case management for provider denial and low-clinical-acuity cases identified by clinical policies and guidelines
Participate in, adhere to, and support compliance, people and culture, and learning programs
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or GED required
Licensed Pharmacy Technician required
Pharmacy, Hospital, or Managed Care experience preferred
Benefit knowledge and experience preferred
Proficient in Microsoft Excel, Power Point, and Word required
Ability to participate in, adhere to, and support compliance program objectives
Ability to consistently interact cooperatively and respectfully with other employees
Remote work is available only to residents of Alabama, Colorado, Florida, Georgia, Indiana, Illinois, Iowa, Kansas, Kentucky, Maryland, Minnesota, Missouri, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia, or Wisconsin
M-F: 8:00 am – 5:00 pm

Benefits

Comp & perks

Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750!
Fully remote work arrangement