Pharmacy Prior Authorization Specialist II

CareSource; United States; On-site; USD 23,000 - 39,000; Full time

Job summary

CareSource in the United States seeks a Pharmacy Technician II to support prior authorization workflows, data entry, and provider/pharmacy assistance within the pharmacy department.

You will review traditional and specialty prior auth requests, communicate with providers by fax or phone, educate about formulary alternatives, and route cases for pharmacist review. This role emphasizes accuracy, regulatory awareness, and teamwork, with opportunities to contribute to process improvements.

Qualifications

• High School Diploma or equivalent required.
• 3 years retail or hospital pharmacy experience preferred.
• 1 year managed care prior authorization experience preferred.

Responsibilities

• Review traditional and specialty prior authorization requests for the member's pharmacy benefit submitted by providers.
• Send fax communications to providers when necessary.
• Contact provider offices to follow up on failed faxes.
• Educate CareSource providers about formulary alternatives.
• Place prior authorizations for when approval is appropriate in the prior authorization system(s).
• Initiate process for routing prior authorizations requiring review by a pharmacist.
• Answer calls from providers regarding prior authorization requests and formulary issues in a timely manner.
• Document all telephonic interactions in appropriate system(s).
• Ensure inquiries (fax, e-mail, ePA) are answered within the state mandated period.
• Assist Case Managers, Member and Provider Services with pharmacy issues, overrides, and questions.

Skills

Windows environment

Microsoft Word

Outlook

Excel

Typing 40 WPM

Telephone communication

Medical terminology

Medication names knowledge

Communication with providers

Independent and team work

Train new employees

Attention to detail

Healthcare knowledge

Medicaid/Marketplace knowledge

Critical thinking

Grammar usage

Time management

Phone etiquette

Customer service

Decision making

Leadership

Education

High School Diploma or equivalent

3 years retail/hospital pharmacy experience

1 year managed care prior authorization experience

Job description

CareSource in the United States seeks a Pharmacy Technician II to support prior authorization workflows, data entry, and provider/pharmacy assistance within the pharmacy department.

You will review traditional and specialty prior auth requests, communicate with providers by fax or phone, educate about formulary alternatives, and route cases for pharmacist review. This role emphasizes accuracy, regulatory awareness, and teamwork, with opportunities to contribute to process improvements.