Pharmacy Technician – Prior Authorization

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Oversee Medicaid and/or Medicare pharmacy services, including the intake and processing of pharmacy authorization requests.

• Advocate for and enhance the quality and effectiveness of healthcare and Pharmacy Services.

• Assess, authorize, and convey decisions regarding pharmacy requests in line with clinical guidelines.

• Review and authorize pharmacy requests received via telephone, facsimile, and other channels using client clinical criteria.

• Assess the appropriateness of medications and relay decisions to physicians, physician office personnel, medical management staff, members, and pharmacists.

• Conduct clinical research to support requests.

• Perform eligibility verification, coordination of benefits (COB), and benefits verification.

• Ensure accurate and comprehensive documentation that complies with risk management, regulatory, and accreditation standards.

• Process requests in accordance with laws, CMS regulations, and organizational policies and procedures.

• Collaborate with Aetna Case Managers, Health Plan Staff, External Pharmacies, and Health Care Providers.

• Foster internal and external communication to improve medication therapy management services.

• Refer requests to a Pharmacist when extensive clinical review or denial is necessary.

• Engage in sedentary tasks that involve prolonged periods of sitting, talking, listening, and typing.

⛳️ Requirements

• A National Pharmacy Technician certification and a current, in good standing Home State License are mandatory.

• Expertise in computerized pharmacy systems and software applications is essential.

• Strong verbal and written communication abilities are required.

• Familiarity with Windows-based software applications is necessary.

• Capability to utilize proprietary systems to build, research, process, and enter requests.

• Maintains the confidentiality of member information and complies with company confidentiality policies.

• A High School diploma or G.E.D. is required.

• Previous experience in retail, hospital, facility, or call center environments is preferred.

• Experience in a high-volume call center and production unit is preferred.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being

• Eligibility for CVS Health bonus, commission, or short-term incentive programs