Pharmacy Technician – Prior Authorizations

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

📋 Description

• Assist in the thorough coordination of Medicaid and/or Medicare pharmacy services, including the intake and processing of pharmacy authorization requests.

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

• Assess, authorize, and relay decisions for pharmacy requests based on clinical guidelines.

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

• Assess medication appropriateness and communicate decisions to physicians, their office staff, medical management personnel, members, and pharmacists.

• Conduct clinical research to support requests.

• Execute non-medical research tasks, including eligibility verification, COB, and benefits verification.

• Ensure accurate and complete documentation that aligns with risk management, regulatory, and accreditation standards.

• Process requests in adherence to laws, CMS regulations, and company 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 an extensive clinical review or denial is necessary.

• Engage in sedentary work involving prolonged periods of sitting, talking, hearing, and keyboarding.

⛳️ Requirements

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

• Proficient in computerized pharmacy systems and software applications.

• Strong verbal and written communication abilities.

• Familiarity with Windows-based software applications.

• Experience using proprietary systems to build, research, process, and enter requests.

• Committed to protecting the confidentiality of member information and adhering to company confidentiality policies.

• Preferred experience in a high-volume call center and production unit.

• Preferred background in retail, hospital, facility, or call center environments.

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• CVS Health bonus, commission, or short-term incentive program.