Remote Pharmacy Utilization Management Specialist

Point32Health, Inc.; Massachusetts; À distance; USD 34 000 - 50 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Résumé du poste

Point32Health, Inc. seeks a Pharmacy Utilization Management Specialist to set up and process drug prior authorizations across multiple applications. You will ensure regulatory compliance and document findings for pharmacist or medical director review.

Remote-friendly position with a mix of home-based and office work. Requires 2+ years in pharmacy, CPhT certification preferred, and strong MS Office skills and attention to detail.

Qualifications

• Certified Pharmacy Technician (CPhT) certification preferred.
• Minimum 2 years of pharmacy experience.
• Experience in managed care/PBM setting preferred.
• Ability to prioritize and process high volumes accurately.

Responsabilités

• Set up full cases from fax, ePA, phone and email PA requests.
• Review cases for regulatory and accreditation requirements and turnaround times.
• Document case notes for PAs requiring pharmacist or medical director review.
• Run test claims for approved authorizations and contact members/providers as needed.
• Interface with providers to process phone PAs and respond to inquiries.
• Perform daily quality checks, manage the UM team inbox, and support process improvements.
• Fulfill other duties and projects as assigned.

Connaissances

MS Office

Prioritization

High accuracy

Pharmacy terminology

Teamwork

Formation

High School Diploma or GED

Associate's degree in Healthcare or related area

Outils

RxClaims

PAHub

Description du poste

Point32Health, Inc. seeks a Pharmacy Utilization Management Specialist to set up and process drug prior authorizations across multiple applications. You will ensure regulatory compliance and document findings for pharmacist or medical director review.

Remote-friendly position with a mix of home-based and office work. Requires 2+ years in pharmacy, CPhT certification preferred, and strong MS Office skills and attention to detail.