Manager, Prior Authorizations
NateraSalary not specified
Full Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
[Remote] Pharmacy Technician - Prior Authorization - Work From Home at CVS Health
Arizona, Texas, United States
Not SpecifiedCompensation
Entry Level & New Grad, Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, PharmacyIndustries
Requirements
- National Pharmacy Technician certification and applicable state Pharmacy Technician license, current and in good standing, must be maintained
- Between 1-5+ years of Pharmacy Prior Authorization experience
- Proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions
- Good written and verbal communication skills
- High level skill with working with PC (e.g., using mouse and keyboard, accessing and navigating through multiple systems and screens)
- Own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord)
- Secure workspace/office in their home
- Ability to work full-time 40 hours per week, including weekends, holidays, rotating schedule, 8-hour shifts between 5:00am-7:00pm (may vary by time zone), possible overnight shifts, extended hours when necessary, and schedule changes based on company needs
- Excellent attendance
- Ability to meet physical demands: frequent speaking/listening with headset, sitting for long periods at computer, use of hands/fingers on keyboard/mouse, using monitors up to 3 hours without break
Responsibilities
- Process prior authorization requests received by phone, fax, or electronically using various computer resources, existing criteria, and medication guidelines to perform clinical research
- Proactively complete prior authorization approvals and denials that are due to expire and maintain complete, timely, and accurate documentation
- Review potential prior authorization denial language to ensure NCQA requirements are met
- Follow prior authorization workflow, policies, and procedures
- Answer high volume of prior authorization inquiry calls from provider offices, pharmacies, and internal partners, and communicate status/decisions using computer resources
- Maintain balance of productivity, quality, and timeliness of work
- Participate in training and continuing education as required
- Participate in team/departmental meetings as required
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
Is this a remote position?
Yes, this is a work-from-home position requiring candidates to have their own home internet access with a minimum speed of 100mbps download, a secure workspace/office in their home, and high-level PC skills.
What are the work hours and schedule like?
Hours of operation are between 5:00am to 7:00pm (may vary by time zone), with 8-hour shifts, rotating weekend schedule required, and work on holidays; full-time requires 40 hours per week, and schedules may change based on company needs.
What skills are required for this pharmacy technician role?
Required skills include proficiency in drug name and diagnosis pronunciation, recognizing medical terminology, navigating multiple computer resources, good written and verbal communication skills, and high-level PC skills for using mouse, keyboard, and multiple systems.
What is the salary for this position?
This information is not specified in the job description.
What makes a strong candidate for this role?
Strong candidates will be proficient in medical terminology, drug pronunciations, computer navigation, have excellent attendance, and strong communication skills, while maintaining productivity, quality, and timeliness in handling high-volume prior authorization requests.
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees