Pharmacy Prior-Authorization Specialist

MedStar Health’s Washington Hospital Center

Waldorf (MD)

On-site

USD 27,000 - 47,000

Full time

7 days ago

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Job summary

MedStar Health’s Washington Hospital Center is seeking a Pharmacy Technician to support safe medication use for enrollees/members. You will process prior authorizations, communicate with patients/providers, and collect data for medical reviewers to evaluate requests.

The role involves PBM reporting, quality measures oversight (HEDIS/EQRO), and developing standard operating procedures under pharmacist supervision.

Qualifications

High School Diploma or GED required.
Associate's degree preferred.
1-2 years experience as a pharmacy technician in an outpatient setting required.
LPT - Licensed Pharmacy Technician required upon hire.
Experience with prior authorization review processes preferred.

Responsibilities

Facilitates accurate and timely processing of medication prior authorization requests.
Communicates with patients, providers, and dispensing pharmacies to support PA requests.
Collects information for Medical Reviewers to complete PA evaluations.
Reviews and finalizes monthly, quarterly, and annual PBM reports; supports PA metrics dashboard.
Assists with QA efforts, quality measures (HEDIS/EQRO) and related initiatives.
Completes required regulatory reports submitted to regulators.
Performs administrative tasks as requested by leadership.
Develops SOPs and workflows; supports process improvements.
Supports precertification for overrides and case management.
Creates a pharmacy resource manual for the team.
Assists with website content management and polypharmacy follow-up.
On-call coverage for PA requests outside normal hours during rotations.
Acts as SME to support interdepartmental projects.