Prior Authorization Pharmacy Technician
Description:
• Use Oscar and vendor tools to verify eligibility, screen required documents, create requests, and track pharmacy prior authorization cases.
• Prepare, organize, and route prior authorization requests for pharmacist or physician review.
• Collect relevant medical information by phone, fax, and portal and apply the appropriate prior authorization criteria.
• Document communications and decision-making clearly and accurately.
• Meet decision-making timeframes and escalate cases requiring pharmacist review promptly.
• Communicate prior authorization decisions through oral and written notifications that meet content and accuracy standards.
• Follow all applicable laws and regulations.
• Support escalated prior authorization issues and complete other duties as assigned.
Requirements:
• 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.
• 1+ years of experience performing pharmacy reviews for a managed care plan or pharmacy benefits manager (preferred).
• Experience working with CVS Caremark's portal and criteria (preferred).
• In-depth understanding of how to operationalize step therapy rules and regulations (preferred).
• Strong verbal and written communication skills and interpersonal skills (preferred).
Benefits:
• Base pay of $19.11 - $25.08 per hour in CA, CT, NJ, NY, and WA, or $17.20 - $22.57 per hour in all other locations.
• Eligible for employee benefits.
• Monthly vacation accrual at a rate of 15 days per year.
• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
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• Use Oscar and vendor tools to verify eligibility, screen required documents, create requests, and track pharmacy prior authorization cases.
• Prepare, organize, and route prior authorization requests for pharmacist or physician review.
• Collect relevant medical information by phone, fax, and portal and apply the appropriate prior authorization criteria.
• Document communications and decision-making clearly and accurately.
• Meet decision-making timeframes and escalate cases requiring pharmacist review promptly.
• Communicate prior authorization decisions through oral and written notifications that meet content and accuracy standards.
• Follow all applicable laws and regulations.
• Support escalated prior authorization issues and complete other duties as assigned.
Requirements:
• 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.
• 1+ years of experience performing pharmacy reviews for a managed care plan or pharmacy benefits manager (preferred).
• Experience working with CVS Caremark's portal and criteria (preferred).
• In-depth understanding of how to operationalize step therapy rules and regulations (preferred).
• Strong verbal and written communication skills and interpersonal skills (preferred).
Benefits:
• Base pay of $19.11 - $25.08 per hour in CA, CT, NJ, NY, and WA, or $17.20 - $22.57 per hour in all other locations.
• Eligible for employee benefits.
• Monthly vacation accrual at a rate of 15 days per year.
• Medical, dental, and vision benefits.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Apply tot his job
Apply To this Job