Job Description:
• Process prior authorization requests received by phone, fax, or electronically
• Use computer resources, existing criteria, and medication guidelines to perform clinical research supporting prior authorization reviews
• Complete expiring prior authorization approvals and denials
• Maintain complete, timely, and accurate documentation
• Review potential prior authorization denial language for NCQA compliance
• Follow prior authorization workflows, policies, and procedures
• Answer high-volume inquiry calls from provider offices, pharmacies, and internal partners
• Communicate prior authorization status or decisions using computer resources
• Balance productivity, quality, and timeliness
• Participate in required training, continuing education, and team or departmental meetings
Requirements:
• National Pharmacy Technician certification required and must be maintained
• Current, active Arizona or applicable state Pharmacy Technician license in good standing required and must be maintained
• 1–5+ years of Pharmacy Prior Authorization processing experience
• Ability to multitask and prioritize work
• Ability to adjust based on business or department needs
• Good organizational skills
• High-level PC skills, including navigating multiple systems and screens
• Own home internet access with minimum 100 Mbps download speed
• Secure workspace/office in the home
• Ability to work 40 hours per week, including weekends and holidays as scheduled
• Ability to work extended hours when necessary
• Rotating weekend schedule may be required
• Proficiency with computerized resources and software applications
• Proficiency with Microsoft Excel, Word, and Outlook
• Knowledge of pharmacy practices and procedures
• Ability to read and understand clinical information
• Working knowledge of drug dosage forms, drug strengths, and generic/brand equivalents
• High school diploma or GED
• Preferred: retail or hospital experience
• Preferred: managed care or Medicaid experience
• Preferred: AS400 experience
Benefits:
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• CVS Health bonus, commission or short-term incentive program eligibility