Prior Authorization Guidelines Specialist I

🕒 July 31

🏄 California – Remote

🏄 California – Remote

💵 $22 - $37 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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MedImpact Healthcare Systems, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1988

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 $1.4M Seed Round on 2013-09

Consulting • Insurance • Logistics

MedImpact Healthcare Systems, Inc. is a pharmacy benefit manager that works with health plans to make pharmacy benefits more accessible and affordable for members. The company serves over 20 million members and handles more than $40 billion annually in pharmacy transactions. MedImpact provides a variety of services including medication reminders, home delivery, and more to empower individuals to manage their prescriptions effectively. By leveraging technology and resources, MedImpact aims to offer a better choice within the pharmacy benefits market and supports health solutions in ensuring convenient and reliable access to medications for its members.

📋 Description

• Provide technical and administrative support to the Fee-For-Service (FFS) Medicaid department • Create and maintain PA Guidelines documents (content management, file maintenance and archiving) • Provide technical and administrative support to the Clinical Program Manager, Clinical PA Guidelines, Drug Information and PA&UM staffs • Communicate with clients to obtain client authorization of final documents and ensure timely distribution • Manage review/QA process for medical exception/prior authorization guidelines prior to implementation

🎯 Requirements

• CL05 - AA and 2+ years’ experience or equivalent combination of education and experience • Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs • Experience with Windows based database programs • Must successfully complete one of the national certification exams OR obtain state licensure (in an U.S. State or Territory) • Maintains a current Pharmacy License and/or CPhT certification without restriction • Understanding of managed pharmacy benefit concepts including formularies, prior authorizations, edits, and claim adjudication

🏖️ Benefits

• Medical / Dental / Vision / Wellness Programs • Paid Time Off / Company Paid Holidays • Incentive Compensation • 401K with Company match • Life and Disability Insurance • Tuition Reimbursement • Employee Referral Bonus