Prior Authorization Pharmacy Technician

Oscar; United States; Remote; USD 23,000 - 34,000; Full time

Job summary

Oscar is hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech team. This remote role supports high-quality pharmacy decision-making and member/provider experience.

You will process prior authorization requests, gather information, and assist with escalated PA issues, reporting to the Pharmacy Technician Supervisor.

Qualifications

• 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience.
• Excellent customer service, phone etiquette, and typing skills.
• Bonus points for experience with CVS Caremark's portal and prior authorization
• Understanding of step therapy rules and regulations.

Responsibilities

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and track PA requests.
• Prepare, organize, and distribute PA requests for review by pharmacist/physician and respond to requests for more information.
• Collect medical information via phone, fax, and portal and apply PA criteria with documented communications.
• Meet required decision timelines and escalate cases needing pharmacist review.
• Communicate PA outcomes clearly and in compliance with standards.
• Comply with all laws and regulations.
• Other duties as assigned.

Skills

Customer service

Typing

Phone etiquette

Attention to detail

Tools

CVS Caremark portal

Job description

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will be dedicated to high quality pharmacy decision-making and improving the member and provider experience. This position is responsible for processing prior authorizations requests and providing support for escalated issues related to prior authorizations.

You will report into the Pharmacy Technician Supervisor.

Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $19.11 - $25.08 per hour. The base pay for this role in all other locations is: $17.20 - $22.57 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests

• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information

• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making

• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review

• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy

• Compliance with all applicable laws and regulations

• Other duties as assigned

Requirements:

• 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience

• Excellent customer service, phone etiquette, and typing skills

Bonus Points:

• 1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager

• Experience working with CVS Caremark's portal and criteria

• In-depth understanding of how to operationalize step therapy rules and regulations

• Strong verbal and written communications, and interpersonal interactions

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·

We like the way you work it · no gig iddy · Gotta bag it up · no gig iddy ·