Remote Pharmacy Utilization & Prior Authorization Specialist

Point32Health, Inc.; United States; Remote; USD 34,000 - 50,000; Full time

Job summary

Point32Health is seeking a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across PA workflows. You will review cases for regulatory compliance and document notes for pharmacists or medical directors.

Requires a CPhT certification, high school diploma and 2+ years of pharmacy experience; experience in managed care or RxClaims/PAHub is preferred. Remote role, standard hours with potential for extended schedules.

Qualifications

• Certified Pharmacy Technician (CPhT) certification is required.
• High School Diploma or GED; Associate's degree or equivalent preferred.
• Minimum of 2 years of pharmacy experience required.
• Managed care/PBM experience and RxClaims/PAHub familiarity are preferred.
• Strong MS Office (Excel, Word, PowerPoint) and ability to prioritize PA requests within turnaround times.

Responsibilities

• Performs full case setup from fax, ePA, phone and email prior authorization requests.
• Performs full case review ensuring regulatory and accreditation requirements and turnaround times are met.
• Documents all relevant PA case notes for pharmacists or medical directors.
• Run test claims for approved authorizations and contact members/providers as needed.
• Communicate with providers via department queue to process PAs and respond to inquiries.
• Daily quality checks, manage Pharmacy UM team email box, handle ePA requests, and support process improvements.

Skills

MS Office

Attention to detail

Multi-tasking

Independent worker

Education

High School Diploma or GED

Associate's degree in Healthcare or related field

Tools

RxClaims

PAHub

Job description

Point32Health is seeking a Pharmacy Utilization Management Specialist to set up and process drug prior authorization cases across PA workflows. You will review cases for regulatory compliance and document notes for pharmacists or medical directors.

Requires a CPhT certification, high school diploma and 2+ years of pharmacy experience; experience in managed care or RxClaims/PAHub is preferred. Remote role, standard hours with potential for extended schedules.