Prior Authorization Pharmacy Technician

Oscar Health

2h•Remote

About The Position

Oscar is hiring a Prior Authorization Pharmacy Technician to join their Pharmacy Tech team. Oscar is a health insurance company that utilizes a full stack technology platform and focuses on serving its members. The role is dedicated to high-quality pharmacy decision-making and improving the member and provider experience. This position is responsible for processing prior authorizations requests and providing support for escalated issues related to prior authorizations.

Requirements

2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience
Active, unrestricted Pharmacy Technician certification (CPhT)
Excellent customer service, phone etiquette, and typing skills

Nice To Haves

1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager
Experience working with CVS Caremark's portal and criteria
In-depth understanding of how to operationalize step therapy rules and regulations
Strong verbal and written communications, and interpersonal interactions

Responsibilities

Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests
Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making
Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy
Compliance with all applicable laws and regulations
Other duties as assigned