Remote Pharmacy Utilization Specialist - Prior Authorization

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

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Full suite of benefits

Job summary

Point32Health is seeking a Pharmacy Utilization Management Specialist to set up and process prior authorization cases across multiple applications. You will review cases for regulatory and accreditation requirements and document notes for pharmacist or medical director review.

In this role you will handle ePA requests, run test claims, respond to provider inquiries, and maintain daily quality checks while supporting the UM team and meeting turnaround times.

Qualifications

• Certified Pharmacy Technician (CPhT).
• High school diploma or GED; an associate’s degree in healthcare, nursing, or related area or equivalent experience.
• Minimum 2 years of pharmacy experience; preferred: managed care/PBM; experience with RxClaims and PAHub.

Responsibilities

• Performs full case setup from fax, ePA, phone and email prior authorization requests.
• Conducts full case review to ensure regulatory and accreditation turnaround times are met.
• Documents all case notes for PAs requiring pharmacist or medical director review.
• Runs test claims for approved authorizations and contacts members/providers as needed.
• Communicates with providers via department queue to process phone PAs and resolve inquiries.
• Performs daily quality checks, manages the UM team email box, responds to provider inquiries, manages ePA requests, and suggests process improvements.
• Performs other roles/duties and projects as assigned.

Skills

MS Office

Prioritize work

High-volume processing

Attention to detail

Medical terminology

Independent and team work

Judgement

Education

High School Diploma or GED

Associate’s degree in Healthcare/Nursing or related area

Tools

RxClaims

PAHub

Job description

Point32Health is seeking a Pharmacy Utilization Management Specialist to set up and process prior authorization cases across multiple applications. You will review cases for regulatory and accreditation requirements and document notes for pharmacist or medical director review.

In this role you will handle ePA requests, run test claims, respond to provider inquiries, and maintain daily quality checks while supporting the UM team and meeting turnaround times.