Pharmacy Technician - Prior Authorizations

SCAN Group; Long Beach (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a forward-thinking organization dedicated to improving senior healthcare as a Prior Authorization Pharmacy Technician. In this pivotal role, you will support the prior authorization process for prescription medications, ensuring timely approvals and effective communication with healthcare providers and pharmacies. Your expertise in managed care practices and pharmacy operations will be crucial in promoting efficient healthcare resource use. Enjoy a remote work environment, competitive salary, and a robust benefits package, including generous PTO and a 401(k) plan. This is an opportunity to make a meaningful impact on the lives of older adults every day.

Benefits

Annual Employee Bonus Program

Robust Wellness Program

Generous Paid-Time-Off (PTO)

Eleven Paid Holidays

401(k) Retirement Saving Plan

Tuition Reimbursement

Employee Recognition Program

Qualifications

• 5+ years of experience in managed care, focusing on prior authorizations.
• Pharmacy Technician License for California preferred.
• Expert knowledge of CMS Medicare Part B and D benefits.

Responsibilities

• Evaluate and process prior authorization requests for medications.
• Coordinate with healthcare providers and pharmacists for PA documentation.
• Maintain accurate records of all PA activities and compliance.

Skills

Managed Care Practices

Clinical Protocols

Pharmacy Operations

Analytical Skills

Problem Solving

Communication Skills

Organizational Skills

Project Management

Education

High School Diploma

Bachelor's Degree

Tools

Microsoft Office 2016

SQL

Tableau

Job description

Description

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

The Job

The Prior Authorization Pharmacy Technician will play a key role in supporting the prior authorization (PA) process for prescription medications. This individual will collaborate with healthcare providers, pharmacies, and insurance companies to ensure timely approval of medications, minimize delays in patient care, and promote efficient use of healthcare resources. The ideal candidate has strong knowledge of managed care practices, clinical protocols, and pharmacy operations, with a focus on prior authorizations and formulary management.

You Will

Review and Process Prior Authorizations: Evaluate and process PA requests for prescription medications based on clinical guidelines and insurance policies.

Coordinate with Providers and Pharmacists: Communicate with healthcare providers to gather necessary clinical information and ensure documentation meets PA requirements.

Utilization of Pharmacy Benefit Management (PBM) Systems: Input, track, and manage prior authorization requests using PBM systems and other managed care platforms.

Adherence to Regulatory Guidelines: Ensure compliance with federal and state regulations, insurance policies, and organizational procedures when processing prior authorization requests.

Documentation and Reporting: Maintain accurate and up-to-date records of all PA activities, including approvals, denials, and follow-up requests.

Customer Service: Respond to inquiries from patients, providers, and internal teams regarding the status of PA requests and related processes.

Continuous Improvement: Assist in identifying opportunities for improving prior authorization workflows and patient outcomes, collaborating with clinical teams to refine processes.

Educate Providers: Provide information to physicians and healthcare teams regarding formulary changes, clinical alternatives, and PA criteria as needed.

All other duties as assigned.

Your Qualifications

High School Diploma or equivalent experience. Bachelor's Degree preferred.

Pharmacy Technician License for the State of California is preferred.

Minimum 5 years of experience in a managed care setting, specifically focused on prior authorization and pharmacy benefit management.

Experience with file management and working with different file formats (e.g. text files).

Regulatory audit experience.

Experience managing small projects from inception through completion.

Claims adjudication experience is preferred.

Experience with analyzing and trending claims data.

Technical expertise - Advanced analytical skills

Problem Solving - Basic problem-solving skills

Communication - Good communication and interpersonal skills

Expert knowledge of CMS Medicare Part B and D benefits, rules and regulations.

PDE knowledge of error resolution and calculations.

Excellent grammar and writing skills. Excellent verbal skill sets to be able to communicate in conference calls and in large meetings.

Team player with a strong work ethic.

Ability to multi-task in a fast pace environment. Ability to prioritize workload and meet deadlines.

Self-starter that can take the lead on a project and manage its progress for completion. Detail oriented and is able to look at large data sets.

Excellent organizational capabilities with ability develop partnerships and strong working relationships within the organization and with the PBM.

Ability to interact effectively and professionally with all levels of staff.

Advanced skills with Microsoft Office 2016 e.g., Word, Excel, Access, SQL and PowerPoint. Familiarity with Tableau is preferred.

What's in it for you?
* Base salary range: $25.38 to $40.62 per hour
* Internal title - Pharmacy Technician, Sr.
* Work Mode - Remote
* An annual employee bonus program
* Robust Wellness Program
* Generous paid-time-off (PTO)
* Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
* Excellent 401(k) Retirement Saving Plan with employer match and contribution
* Robust employee recognition program
* Tuition reimbursement
* An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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