Pharmacy Prior Authorization Specialist

w3r Consulting; City of Rochester (NY); Remote; USD 42,000 - 64,000; Full time

Job summary

w3r Consulting is seeking a Pharmacy Prior Authorization Technician to perform initial level processing and review of prior authorization requests for pharmacy and medical specialty drug reviews. The role uses policy guidelines and supports utilization management decisions.

You will serve as a content expert for authorization applications, assist staff with contract benefits, and act as a lead liaison coordinating with pharmacy and medical claim systems.

Qualifications

• High school diploma with a minimum of two years' experience in health-related field is required; an associates degree is preferred.
• Pharmacy Technician certification (CPhT), LPN, Medical Assistant/Technologist background strongly preferred.

Responsibilities

• Conducts initial level medication prior-authorization reviews to determine coverage under the member's benefit.
• Routes cases to pharmacist/medical director for final determination, as directed.
• Issues verbal and written member notification as required.
• Reviews and interprets prescription and medical benefit coverage across lines of business to determine review type.
• Develops and implements process improvements to increase efficiency in the review process.
• Acts as a content expert for prior authorization intake and coverage.
• Provides phone support for UM processes and related inquiries.
• Maintains knowledge of sources of information about health plan contracts and procedures.

Skills

Pharmacy Technician certification (CPh

LPN

Medical Assistant/Technologist

Education

High school diploma with a minimum of two years' experience in health-related field

Associates degree preferred

Job description

w3r Consulting is seeking a Pharmacy Prior Authorization Technician to perform initial level processing and review of prior authorization requests for pharmacy and medical specialty drug reviews. The role uses policy guidelines and supports utilization management decisions.

You will serve as a content expert for authorization applications, assist staff with contract benefits, and act as a lead liaison coordinating with pharmacy and medical claim systems.