Pharmacy Technician - Prior Authorization - Work From Home

CVS Health•Work At Home-Oklahoma, OK

1d•$19 - $32•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This role supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. It promotes and supports quality effectiveness of healthcare and Pharmacy Services. The Pharmacy Technician evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines. They evaluate and authorize approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. The role determines appropriateness for medications and communicates decisions to physicians, physician’s office staff, medical management staff, members, and/or pharmacists. The position will perform clinical research to support requests and non-medical research including eligibility verification, COB, and benefits verification. It maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. Requests are processed in compliance with various laws and CMS regulations and company policies and procedures. The role may communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers. It promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services. This is a sedentary work position involving significant periods of sitting, talking, hearing, and keying. The role escalates requests to a Pharmacist when a request requires extensive clinical review or denial.

Requirements

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.

Nice To Haves

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

Responsibilities

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.
Performs 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.
Escalates requests to Pharmacist when request requires extensive clinical review or denial.