Prior Authorization Pharmacy Technician

About the role:

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.

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

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

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