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CVS Health

Runs pharmacies, health plans and clinics

Pharmacy Technician - Prior Authorization

PharmacyPosted on Nov 3
Full-timeArizona, USA

About the Job

Requirements

  • Maintain current, good-standing National Pharmacy Technician certification and Arizona State Pharmacy Technician license.
  • Have 1–5+ years of pharmacy prior-authorization processing experience.
  • Have high-level PC skills, including using a mouse and keyboard and navigating multiple systems and screens.
  • Have home internet access with a minimum download speed of 100 Mbps.
  • Maintain a secure workspace or office at home.
  • Be able to work extended hours when necessary, including scheduled shifts within operating hours, weekends, and holidays; rotating weekends may be required.
  • Have the ability to multitask and prioritize work.
  • Have the ability to adjust based on business or department needs.
  • Have good organizational skills.
  • Have a high school diploma or GED.

Responsibilities

  • Process prior-authorization requests received by phone, fax, or electronically, using computer resources, existing criteria, and medication guidelines to conduct clinical research supporting prior-authorization reviews.
  • Proactively complete prior-authorization approvals and denials that are due to expire, maintaining complete, timely, and accurate documentation.
  • Review potential prior-authorization denial language to ensure NCQA requirements are met.
  • Follow prior-authorization workflows, policies, and procedures during the workday.
  • Answer potentially high-volume inquiry calls from provider offices, pharmacies, and internal partners, using computer resources to communicate prior-authorization status or decisions.
  • Maintain productivity, quality, and timeliness of work.
  • Participate in required training, continuing education, and team or departmental meetings.
  • Pronounce drug names and diagnoses, recognize medical terminology, and navigate multiple computer resources to document conversations and prior-authorization decisions.

Desired Qualifications

  • Retail or hospital experience.
  • Managed care or Medicaid experience.
  • AS400 experience.
  • Proficiency with computerized resources and software applications.
  • Proficiency with Microsoft Excel, Word, and Outlook.
  • Knowledge of pharmacy practices and procedures, and ability to read and understand clinical information.
  • Working knowledge of drug dosage forms, drug strengths, and generic and brand-name equivalents.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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