Job Description:
• Reviews prior authorization requests and units for medications requested under the medical benefit
• Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
• Sends notification to members and providers of authorization decisions via telephone, fax, or mail
• Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
• Establishes great rapport with Provider offices via telephonic communication
• Sends request for information sheets to Providers
• Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
Requirements:
• High School Diploma or GED from an accredited institution
• Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
• Experience conducting prior authorization reviews
• Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional.
Benefits:
• medical, dental and vision coverage
• incentive and recognition programs
• life insurance
• 401k contributions