Prior Authorization Guidelines Specialist I

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

📋 Description

• Offer both technical and administrative assistance to the Fee-For-Service (FFS) Medicaid division.

• Develop and uphold PA Guidelines documents, including content management, file maintenance, and archiving.

• Support the Clinical Program Manager, Clinical PA Guidelines, Drug Information, and PA&UM teams with technical and administrative tasks.

• Liaise with clients to secure authorization for final documents and guarantee prompt distribution.

• Oversee the review and quality assurance process for medical exception/prior authorization guidelines before they are put into effect.

⛳️ Requirements

• CL05 - Associate's Degree and a minimum of 2 years of experience or a suitable combination of education and experience.

• Proficient in MS Office/Word, Excel, and Outlook, with a strong ability to learn new software.

• Familiarity with Windows-based database applications.

• Must successfully pass one of the national certification examinations or acquire state licensure (in a U.S. State or Territory).

• Possess a current Pharmacy License and/or CPhT certification without any restrictions.

• Comprehension of managed pharmacy benefit concepts, including formularies, prior authorizations, edits, and claims adjudication.

🏝️ Benefits

• Medical, Dental, Vision, and Wellness Programs.

• Paid Time Off and Company Paid Holidays.

• Incentive Compensation.

• 401K plan with Company matching.

• Life and Disability Insurance.

• Tuition Reimbursement.

• Employee Referral Bonus.