[Hiring] Pharmacy Technician - Prior Authorization @CVS Health

Role Description

• Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests.
• Promotes and supports quality effectiveness of healthcare and Pharmacy Services.
• Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.
• Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria.
• Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, members, and/or pharmacists.
• Will perform clinical research to support request.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Process requests in compliance with various laws and CMS regulations and company policies and procedures.
• May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers.
• Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services.
• Sedentary work involving significant periods of sitting, talking, hearing, and keying.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.

Qualifications

• National Pharmacy Technician certification and Home State License, current and in good standing, are required.
• Proficiency in computerized pharmacy systems and software applications.
• Excellent verbal and written communication skills.
• Experience with Windows-based software applications.
• Utilizes various proprietary systems to build, research, process and enter requests.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Requirements

• High volume call center and production unit experience preferred.
• Experience in retail, hospital, facility or call center is preferred.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.