Pharmacy Benefits Specialist - Prior Authorization

The Health Plan Of West Virginia Inc; Wheeling (WV); Vor Ort; USD 25.000 - 33.000; Teilzeit

Zusammenfassung

The Health Plan Of West Virginia Inc is recruiting a Pharmacy Technician – Temporary Part Time in Wheeling, WV. You will assist members, providers, and pharmacists with coverage requests, prior authorizations, and communications per plan rules.

The role supports medication review and coordination, using PBM and clinical systems. Strong organizational skills and ability to work in a team are essential for successful care management.

Qualifikationen

• High school diploma or equivalent.
• One year of experience in a retail, hospital, managed-care or similar pharmacy setting.
• Minimum typing speed of 35 words per minute.
• Knowledge of pharmaceutical generic and trade names.
• Ability to follow established policies and procedures.

Aufgaben

• Processes medication coverage requests via prior authorization criteria.
• Contacts providers to obtain information for coverage requests.
• Attaches relevant policies to case documents for review.
• Documents policy information before referral to clinical pharmacists or medical directors.
• Communicates decisions to physicians or members per company policies.
• Resolves inquiries and documents outcomes in the PBM system or CRM tools.
• Gathers clinical documentation for medication reconciliation and reviews.

Kenntnisse

Retail pharmacy experience

Medical terminology

Excel

Communication skills

Typing speed 35 wpm

Teamwork

Ausbildung

High School diploma or equivalent

Degree in health-related field

Jobbeschreibung

The Health Plan Of West Virginia Inc is recruiting a Pharmacy Technician – Temporary Part Time in Wheeling, WV. You will assist members, providers, and pharmacists with coverage requests, prior authorizations, and communications per plan rules.

The role supports medication review and coordination, using PBM and clinical systems. Strong organizational skills and ability to work in a team are essential for successful care management.