Pharmacy Technician - Prior Authorizations - Work From Home
Core
Coordinates Medicaid and Medicare pharmacy services by evaluating, authorizing, and communicating approval decisions for pharmacy requests based on clinical guidelines.
Role type
Pharmacy Technician (Prior Authorizations)
Builds
Pharmacy authorization workflows and medication therapy management services
Domain
Healthcare / Pharmacy / Insurance Administration
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical criteria evaluation, medication appropriateness determination, clinical research, eligibility verification, COB verification, benefits verification, regulatory compliance, documentation management, proprietary system navigation
Preferred skills
High-volume call center experience, retail/hospital/facility experience
Technologies
Windows-based software applications, computerized pharmacy systems
Responsibilities
Intake and process pharmacy authorization requests, evaluate and authorize approval of pharmacy requests via telephone/fax, communicate decisions to physicians and pharmacists, perform clinical and non-medical research, maintain accurate documentation, escalate complex requests to pharmacists
Seniority
Individual Contributor, operational level