Managed Care Pharmacy Tech: Prior Authorization Specialist

Univera HealthСare; City of Albany (NY); Teletrabalho; USD 29 000 - 46 000; Tempo integral

Resumo da oferta

Univera Healthcare in New York State is seeking a Managed Care Pharmacy Technician to support pharmacy benefits optimization, prior authorizations, and member communications. You will work under a licensed pharmacist, handle live calls to members and physicians, and participate in on-call rotations to support after-hours inquiries.

Responsibilities include reviewing medical exceptions, assisting with data entry, and implementing formulary tools.

Qualificações

• High school diploma plus 2 years in health-related field.
• CPhT certification or equivalent strongly preferred.
• LPN or Medical Assistant background advantageous.
• Familiarity with medical terminology and diagnosis codes.
• Good understanding of prescription and medical benefits.
• Proficient with Microsoft Office Suite.
• Strong verbal and written communication skills.
• Professionalism and customer service orientation.
• Able to work independently and meet deadlines.
• Willingness to cover on-call and late shifts.

Responsabilidades

• Review medical exception requests based on pharmacist-created algorithms.
• Evaluate clinical documentation for prior authorization approval.
• Enter data and monitor member profiles for requests and reports.
• Provide information via telephone to physicians and pharmacists about initiatives.
• Provide real-time authorization of prescription requests for various scenarios.
• Implement formulary utilization management tools (prior authorization, quantity limits, etc.).
• Collaborate with internal/external customers to resolve system issues related to benefits.
• Research mail-order, specialty pharmacy, or plan claims in the Facets system.
• Back up Pharmacy Benefits Team phone queue as needed.
• Monitor PBM interfaces for eligibility, claims, formulary issues; perform testing.
• Support quality improvement and productivity standards with management.

Formação académica

High school diploma

CPhT certification

LPN

Medical Assistant background

Associates degree preferred

Ferramentas

Microsoft Office

Descrição da oferta de emprego

Univera Healthcare in New York State is seeking a Managed Care Pharmacy Technician to support pharmacy benefits optimization, prior authorizations, and member communications. You will work under a licensed pharmacist, handle live calls to members and physicians, and participate in on-call rotations to support after-hours inquiries.

Responsibilities include reviewing medical exceptions, assisting with data entry, and implementing formulary tools.