Clinical Prior Authorization Technician (Temp to Hire)

2 hours, 2 minutes ago
Contract
Junior
Customer and Technical Support
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Prepare complex prior authorization requests by identifying applicable clinical guidelines and ensuring sufficient clinical information is available for pharmacist review.
  • Proactively obtain clinical information from prescribers, referral coordinators, and other appropriate staff to complete guideline review.
  • Use problem-solving skills to identify information gaps and resolve concerns from clients, members, pharmacy personnel, and providers.
  • Review and analyze pharmacy claims data for proactive outreach and intervention.
  • Create decision trees from clinical guidelines to support the prior authorization department.
  • Triage calls from members, pharmacy personnel, and providers by asking drug-specific and client-specific clinical questions.
  • Communicate issues and resolutions to members, pharmacy staff, providers, and internal stakeholders.
  • Train and ensure call center pharmacy technicians follow proper intake protocols and best practices for prior authorization requests received by phone, fax, mail, and electronically.
  • Perform initial review of prior authorization and formulary exception requests based on established clinical and contract criteria.
  • Support the Fraud, Waste, and Abuse program by reviewing pharmacy claims information and sharing findings with internal staff.
  • Assist leadership with departmental projects and follow internal standard operating procedures.

Requirements

  • Minimum of 1 year of experience as a UM Technician I at Capital Rx.
  • State or National Certified Pharmacy Technician (CPhT) license required.
  • High school diploma or equivalent required; associate’s or bachelor’s degree preferred.
  • Excellent communication, writing, and organizational skills.
  • Ability to multitask and collaborate in a team environment.
  • Self-motivated, detail-oriented problem solver.
  • Demonstrated project management skills.
  • Remote work location within the U.S. only.

Benefits

  • Remote position open to U.S.-based candidates.
  • Salary range of $50,000 to $60,000 USD.
  • Opportunity to work on enterprise health technology and pharmacy benefit management operations.
  • Equal employment opportunity and a diverse workplace environment.

Interested in this position?

Apply directly on the company website

Apply Now

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