[Hiring] Prior Authorization Pharmacy Technician @Oscar Health

Role Description

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech team. You will be dedicated to high quality pharmacy decision-making and improving the member and provider experience. This position is responsible for processing prior authorizations requests and providing support for escalated issues related to prior authorizations. You will report into the Pharmacy Technician Supervisor.

Work Location:
• This is a remote position, open to candidates who reside in:
• Alabama
• Arizona
• Arkansas
• Colorado
• Connecticut
• District of Columbia
• Florida
• Georgia
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Missouri
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• North Carolina
• Ohio
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency:
• The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $19.11 - $25.08 per hour.
• The base pay for this role in all other locations is: $17.20 - $22.57 per hour.
• You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities
• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests.
• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information.
• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making.
• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review.
• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Qualifications
• 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience.
• Active, unrestricted Pharmacy Technician certification (CPhT).
• Excellent customer service, phone etiquette, and typing skills.

Bonus Points
• 1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager.
• Experience working with CVS Caremark's portal and criteria.
• In-depth understanding of how to operationalize step therapy rules and regulations.
• Strong verbal and written communications, and interpersonal interactions.

Benefits
• Full-time employees are eligible for benefits including: medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation.
• Life and disability insurance.
• Paid wellness time and reimbursements.

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