Manager, Prior Authorizations
NateraSalary not specified
Pharmacy Technician - Prior Authorization - Work From Home at CVS Health
Texas Twp, Michigan, 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, required and must be maintained
- Between 1-5+ years of Pharmacy Prior Authorization processing experience
- Ability to multi-task and prioritize work
- Ability to adjust based on business or department needs
- Good organization skills
- Own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord)
- Secure workspace/office in home
- High level skill with working with PC (e.g., using mouse and keyboard, accessing and navigating through multiple systems and screens)
- 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
- Excellent attendance
- Ability to work full-time 40 hours per week, including rotating weekends, holidays, and potentially extended hours; 8-hour shifts between 5:00am-7:00pm (may vary by time zone), overnight shifts possible but not guaranteed
- Frequent speaking and listening using a headset, sitting for long periods, 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; utilize various computer resources, existing criteria, and medication guidelines to perform clinical research supporting prior authorization reviews
- Proactively complete prior authorization approvals and denials due to expire; 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 during the workday
- Answer high volume of prior authorization inquiry calls from provider offices, pharmacies, and internal partners; use computer resources to communicate status or decisions
- 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
Prior Authorization
Pharmacy Technician
Medical Terminology
Clinical Research
NCQA Compliance
Drug Knowledge
Diagnosis Pronunciation
Computer Navigation
Verbal Communication
Written Communication
Documentation
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
