Prior Authorization Pharmacy Technician – Seasonal

🔥 0 minutes ago

🏈 Alabama, Alaska, +45 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $28 / hour

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

💊 Pharmacist

👻 Ghost score 1%

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SmithRx

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $20M Series B on 2022-03

Consulting • Insurance • Healthcare

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

📋 Description

• Assist members, providers, pharmacies, and internal SmithRx teams in navigating prescription complexities and timely medication coverage • Verify eligibility and drug coverage under plan benefit designs for appropriate claims processing • Triage clinical review processes for prior authorization requests according to established protocols • Review prior authorization requests using criteria, claims history, and plan benefit rules • Conduct prescriber and pharmacy outreach to verify and gather required information • Organize and prioritize requests for timely prior authorization case management • Build and adjust authorizations in the claim adjudication system • Navigate drug products and formulations and perform basic calculations to monitor accurate claims adjudication • Assess and synthesize multiple workflows and protocols to make sound clinical decisions • Coordinate cross-team outreach, questions, escalations, processes, and protocols • Evaluate member clinical situations against medication policies and approve or triage cases to a Pharmacist for denial • Determine when medications require internal or external review • Contact selected external stakeholders for approval on drugs with dollar limits

🎯 Requirements

• High School diploma or GED or equivalent work experience • Active Pharmacy Technician license required • 2-4 years of experience as a Pharmacy Technician • 2+ years of experience in prior authorization review, specifically working on the approval side at a PBM or health plan, required • Proficiency in Mac, MS Office, and G-Suite required • Critical thinking to navigate complex customized benefit plans and make sound clinical decisions • Active listening and conversational speaking skills, with a high degree of empathy • Ability to multitask, prioritize, and manage time effectively • Ability to communicate clearly and present complex information to members, clients, pharmacies, providers, and internal teams • Ability to work accurately within protocols and follow appropriate escalation pathways

🏖️ Benefits

• Time off programs • Medical insurance • Dental insurance • Vision insurance • Mental health support • Paid parental leave • Life insurance • Disability insurance • 401(k) • May be eligible for bonuses, commissions, or equity