Remote Pharmacy Prior Authorization Specialist – Appeals

CommuniCare Health; Broadview Heights (OH); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k) with company match

Paid time off

Job summary

CommuniCare Health is seeking a Pharmacy Prior Authorization Specialist for a full-time remote role. This position involves managing the Prior Authorization workflow for facilities in states including Ohio and West Virginia. The successful candidate will submit prior authorizations, resolve discrepancies, and ensure compliance with federal and state regulations. Ideal for those with prior authorization or Long-Term Care pharmacy experience, offering comprehensive benefits including health insurance and a 401(k) match.

Qualifications

• Prior Authorization experience preferred, but not required.
• Previous Long-Term Care pharmacy experience is a plus.
• Knowledge of Framework LTC is a plus.

Responsibilities

• Maintain the Prior Authorization workflow for assigned facilities.
• Submit prior authorizations to respective plans.
• Work directly with insurance companies for resolution.

Job description

CommuniCare Health is seeking a Pharmacy Prior Authorization Specialist for a full-time remote role. This position involves managing the Prior Authorization workflow for facilities in states including Ohio and West Virginia. The successful candidate will submit prior authorizations, resolve discrepancies, and ensure compliance with federal and state regulations. Ideal for those with prior authorization or Long-Term Care pharmacy experience, offering comprehensive benefits including health insurance and a 401(k) match.