Medication Prior Authorization Specialist

DeKalb Health; North Charleston (SC); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

401K with generous company match

Short Term and Long Term Disability

Job summary

Palmetto Primary Care Physicians (PPCP) in South Carolina is seeking a Pharmacy Technician to manage prior authorizations, assist with documentation, and collaborate with providers, payers, pharmacists, and patients to ensure timely approvals and quality patient care.

Requires a GED or high school diploma, SC tech license, and 2 years of pharmacy experience; ECW and Excel skills are preferred. PPCP offers a 401K with generous match and disability coverage.

Qualifications

• GED or High School Diploma required.
• Minimum of 2 years’ experience in a pharmacy setting preferred. Proficient PC skills including ECW and Microsoft Excel preferred.
• Licensed Pharmacy Technician, State of SC certification.

Responsibilities

• Completes prior authorization requests for medication.
• Assures timely completion of all prior authorization requests with a goal of no longer than 72 hours turn-around time.
• Assists with medical necessity documentation to expedite approvals of medications and procedures.
• Collaborates with providers/payers/pharmacist/patients to assure appropriateness of medications/ procedures needing prior authorization and to reduce barriers to patient receiving quality patient care.
• Partners and collaborates with other departments cross functionally regarding prior- authorization and/or clinical care services.
• Adapts departmental plans and priorities to address business and operational challenges.
• Build effective and professional relationships with internal (PPCP) and external (community) providers.
• Attends all care coordination meetings.
• Other duties as assigned.

Skills

Proficient PC skills

Education

GED or High School Diploma

Tools

ECW

Microsoft Excel

Job description

• Location 2500 ELMS CENTER RD,North Charleston, SC, 29406,United States
• Employee Type Full Time
• Manage Others No

Description

Palmetto Primary Care Physicians (PPCP) is the largest independent multi-specialty group practice in South Carolina. The group is comprised of over 100 clinical providers with a wide range of expertise in primary and specialty care including endocrinology, gastroenterology, neurology, psychiatry, audiology and physical therapy.

PPCP has proudly served patients since 1996 and is known for their innovative patient centered delivery model. The group was among one of the first practices to nationally establish a successful Patient Centered Medical Home Program and the first in South Carolina. Today PPCP offers a wide range of services, including a state-of-the-art urgent care clinic, imaging, diagnostics and labs.

• Offer 401K with generous company match
• Short Term and Long Term Disability Offered

Requirements

Job Functions:

• Completes prior authorization requests for medication.
• Assures timely completion of all prior authorization requests with a goal of no longer than 72 hours turn-around time.
• Assists with medical necessity documentation to expedite approvals of medications and procedures.
• Collaborates with providers/payers/pharmacist/patients to assure appropriateness of medications/ procedures needing prior authorization and to reduce barriers to patient receiving quality patient care.
• Partners and collaborates with other departments cross functionally regarding prior- authorization and/or clinical care services.
• Adapts departmental plans and priorities to address business and operational challenges.
• Build effective and professional relationships with internal (PPCP) and external (community) providers.
• Attends all care coordination meetings.
• Other duties as assigned.

Position Qualifications:

• Education: GED or High School Diploma required
• Experience: Minimum of 2 years’ experience in a pharmacy setting preferred. Proficient PC skills including ECW and Microsoft Excel preferred.
• Licensure/Certification: Licensed Pharmacy Technician, State of SC certification

Summary

Job Summary:

Supports the organization’s mission, vision, and values by exhibiting compassion, integrity, accountability and excellence. Serves as a key member of the interdisciplinary patient care team, collaborating with providers, colleagues, patients, and family members to promote a patient-driven model of care that ensures the delivery of quality and cost-effective healthcare services.