Pharmacy Technician - Prior Auth - MedPharm
Company: Envolve Pharmacy
Posted on: January 23, 2023
You could be the one who changes everything for our 26 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
Pharmacy Technician - Prior Auth - Part B / MedPharm - Remote -
Track and triage all coverage determination requests for prior
authorizations and Medicare Part B / MedPharm recipients.
Position Purpose: The Pharmacy Technician may perform duties in one
or more of the following areas: Formulary Management, Pharmacy
Audit and Recovery, Pharmacy Service Center or Prior Authorization,
Medicare Part D Operations and State Health Programs Pharmacy
Operations. Using established company guidelines, the Pharmacy
Technician reviews requests made by physicians, medical groups,
pharmacies and members for the use of prescription drugs and
pharmacy benefits. The technician researches and resolves
questions, problems or issues. May consult with Clinical
Pharmacists on related issues.
Reviews requests made by physicians and pharmacies for use of
prescription drugs that are non-formulary, have prior authorization
requirements, have exceeded quantity or cost limits, or require
assistance in on-line processing of a prescription claim.
Assign, enter and document prior authorizations into appropriate
claims processing system.
Answer phone calls for prior authorization inquiries
Researches and resolves issues using the appropriate reference
Responsible for knowing and interpreting pharmacy and medical
Education/Experience: High School diploma or GED required. 1 year
Pharmacy Technician experience.
Highly Preferred - Managed Care and/or Hospital with Prior
License/Certification: Valid Pharmacy Technician License
Job Specific Details:
- Track and triage coverage determination and/or prior
authorization requests submitted from providers and determine if a
pharmacist review is required.
- Obtain verbal authorizations and request detailed clinical
information from prescribers.
- Approve coverage determination and/or prior authorization
requests based on defined criteria.
- Enter and document coverage determination and/or prior
authorization request decisions into the PBM system and notify
providers and/or members.
- Respond to client inquiries regarding authorization approvals
and PBM online applications.
- Refer coverage determination requests for specialty drugs to
delegated vendor or client for processing.
- Contact providers for additional information to facilitate
coverage determination reviews.
- Notify physicians, providers, and members of coverage
determination request decisions. Shift(s): 10am-6:30pm (In your
time zone) Sunday - Thursday or Tuesday-Saturday or 10am -6:30pm
Monday - Friday with a full weekend rotation (Saturday & Sunday
hours are 8am - 4:30pm (EST every 3-4 weeks depending on staffing &
Location: Remote - Work-from-home
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
Centene is an equal opportunity employer that is committed to
diversity, and values the ways in which we are different. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability, veteran status, or
other characteristic protected by applicable law.
Keywords: Envolve Pharmacy, Tallahassee , Pharmacy Technician - Prior Auth - MedPharm, Healthcare , Tallahassee, Florida
Didn't find what you're looking for? Search again!