Pharmacy Technician – Prior Authorizations

Job not on LinkedIn

🔥 6 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Support comprehensive coordination of Medicaid and/or Medicare pharmacy services, including intake and processing of pharmacy authorization requests • Promote and support quality effectiveness of healthcare and Pharmacy Services • Evaluate, authorize approval, and communicate decisions for pharmacy requests according to clinical guidelines • Evaluate and authorize pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria • Determine medication appropriateness and communicate decisions to physicians, physician office staff, medical management staff, members, and pharmacists • Perform clinical research to support requests • Perform non-medical research including eligibility verification, COB, and benefits verification • Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements • Process requests in compliance with laws, CMS regulations, and company policies and procedures • Communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies, and Health Care Providers • Promote internal and external communication to enhance medication therapy management services • Escalate requests to a Pharmacist when extensive clinical review or denial is required • Perform sedentary work involving significant periods of sitting, talking, hearing, and keying

🎯 Requirements

• National Pharmacy Technician certification and Home State License, current and in good standing, are required • Proficiency in computerized pharmacy systems and software applications • Excellent verbal and written communication skills • Experience with Windows-based software applications • Experience utilizing proprietary systems to build, research, process and enter requests • Protects the confidentiality of member information and adheres to company confidentiality policies • High volume call center and production unit experience preferred • Experience in retail, hospital, facility or call center preferred • High School diploma or G.E.D.

🏖️ 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