Remote Pharmacy Utilization Management Specialist

Point32Health, Inc.; Oklahoma City (OK); Hybrid; USD 34.000 - 50.000; Vollzeit

Benefits dieser Stelle

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance with buy

Tuition program

Well-being benefits

Zusammenfassung

Point32Health, Inc. is seeking a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across multiple applications under supervision. You will review cases for regulatory and accreditation compliance and document notes for pharmacy or medical director review.

The role requires CPhT certification, 2 years of pharmacy experience, and familiarity with RxClaims and PAHub. Some early/extended hours and remote work options are possible as program dictates.

Qualifikationen

• Certification and licensure: Certified Pharmacy Technician (CPhT).
• Education: High School Diploma or GED; Associate's degree in Healthcare, Nursing, or related area or equivalent experience.
• Experience: 2 years of pharmacy experience required.
• Preferred: Experience in managed care/PBM setting.
• Software/Database experience: RxClaims and PAHub.

Aufgaben

• Performs full case set up from fax, ePA, phone and email PA requests.
• Performs full case review ensuring regulatory and accreditation requirements and timelines.
• Document case notes for PAs needing pharmacist or medical director review.
• Run test claims for approved authorizations; contact members/providers as needed.
• Communicate with providers to process phone PAs and resolve inquiries.
• Perform daily quality checks and manage the Pharmacy UM team email box; respond to inquiries.

Kenntnisse

CPhT

PA processing

Regulatory knowledge

Medical terminology

Prior authorization

Ausbildung

High School Diploma

Associate's degree in Healthcare

Tools

RxClaims

PAHub

Jobbeschreibung

Point32Health, Inc. is seeking a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across multiple applications under supervision. You will review cases for regulatory and accreditation compliance and document notes for pharmacy or medical director review.

The role requires CPhT certification, 2 years of pharmacy experience, and familiarity with RxClaims and PAHub. Some early/extended hours and remote work options are possible as program dictates.