Pharmacy Prior Authorization Coordinator I

Sentara Healthcare • Richmond, VA

420d

About The Position

The Pharmacy Prior Authorization Coordinator I at Sentara Healthcare is a full-time remote position responsible for supporting the Pharmacy Department's operations, particularly in the call center and prior authorization cases across various lines of business including Medicaid, Medicare, Exchange, and Commercial. The role involves handling inquiries from members and providers regarding pharmacy benefits and prior authorizations, utilizing pharmacy computer systems to facilitate these processes, and acting as an internal resource to resolve pharmacy claims and authorization issues.

Requirements

• High School diploma or GED required.
• Certified Pharmacy Technician (CPhT) certification required.
• 1 year of Pharmacy Technician experience required.
• Experience in a Pharmacy Call Center or Authorization preferred.
• Managed Care, Health Plan, or PBM experience preferred.
• State Registration required based on location (VA or NC).

Nice To Haves

• Experience in managed care environments.
• Familiarity with health plans or pharmacy benefit managers (PBM).

Responsibilities

• Support the Pharmacy Department's day-to-day operations for the call center and prior authorization cases.
• Handle member/provider requests and inquiries regarding pharmacy benefits and prior authorizations.
• Utilize the pharmacy computer system to facilitate prior authorizations.
• Participate in patient/provider/customer care activities that do not require the expertise of a pharmacist.
• Interface with members, providers, and internal departments to resolve pharmacy claims and prior authorization issues.

Benefits

• 401(a)
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Tuition reimbursement
• Paid time off
• Vision insurance
• 403(b)
• Opportunities for advancement
• Life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED