Remote Pharmacy Prior Authorization Specialist

Point32Health, Inc.; Adams (MA); Hybrid; USD 34,000 - 50,000; Full time

Benefits offered by this job

Medical, dental and vision

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health, Inc. is hiring a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across multiple channels, ensuring regulatory compliance and timely turnaround.

The role requires a Certified Pharmacy Technician (CPhT) with at least 2 years of pharmacy experience, preferably in managed care/PBM settings, and proficiency in RxClaims and PAHub.

Qualifications

• High School Diploma or GED required; Associate's degree preferred.
• 2 years of pharmacy experience required; PBM/managed care experience preferred.

Responsibilities

• Set up cases for drug prior authorizations from fax, ePA, phone, and email.
• Perform full case review to meet regulatory and turnaround times.
• Document case notes for PAs needing pharmacist or medical director review.
• Run test claims for approved authorizations and contact members/providers as needed.
• Communicate with providers to process phone PAs and answer inquiries.
• Conduct daily quality checks and manage the Pharmacy UM email box and ePA requests.
• Support process improvements and participate in special projects.

Skills

MS Office

Prioritization

High accuracy

Attention to detail

Medical terminology

Independent & team

Judgement

Education

High School Diploma or GED

Associate's degree in Healthcare/Nursing/related

Tools

RxClaims

PAHub

Job description

Point32Health, Inc. is hiring a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across multiple channels, ensuring regulatory compliance and timely turnaround.

The role requires a Certified Pharmacy Technician (CPhT) with at least 2 years of pharmacy experience, preferably in managed care/PBM settings, and proficiency in RxClaims and PAHub.