Pharmacy Prior Authorization Specialist

CVS Health Corporation; Arizona; Hybrid; USD 38,000 - 73,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement options

Wellness programs

Job summary

CVS Health is seeking a Pharmacy Technician for Prior Authorization to support clinical reviews and ensure timely approvals and denials. You will use multiple systems, follow NCQA guidelines, and document conversations and decisions.

This full-time role requires national certification/licensure, 1–5+ years of experience, and the ability to multitask and prioritize in a fast-paced environment. Weekend rotation and extended hours may be required.

Qualifications

• National Pharmacy Technician certification and applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained
• Between 1-5+ years of Pharmacy Prior Authorization processing experience
• Ability to Multi-task and prioritize work
• Ability to adjust based on business or department needs
• Good organization skills

Responsibilities

• Processes prior authorization requests received by phone, fax, or electronically and uses criteria to perform clinical research to support prior authorization reviews
• Proactively completes prior authorization approvals and denials that are due to expire with complete, timely documentation
• Reviews potential denial language to ensure NCQA requirements are met
• Follows prior authorization workflow, policies, and procedures
• Answers high volume inquiries from providers, pharmacies, and internal partners and communicates decisions
• Maintains a balance of productivity, quality and timeliness of work
• Participates in training and continuing education as required
• Participates in team/departmental meetings as required
• Proficient in drug name and diagnosis pronunciation and navigating multiple systems
• Good written and verbal communication skills

Skills

Certification/licensure

Prior authorization experience

Multi-tasking

Adaptability

Organization

Education

High School diploma

Tools

AS400

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

CVS Health is seeking a Pharmacy Technician for Prior Authorization to support clinical reviews and ensure timely approvals and denials. You will use multiple systems, follow NCQA guidelines, and document conversations and decisions.

This full-time role requires national certification/licensure, 1–5+ years of experience, and the ability to multitask and prioritize in a fast-paced environment. Weekend rotation and extended hours may be required.