We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our healthcare team.
Location: Rochester, NY
Work Mode: On-site
Role: Prior Authorization Specialist
Job Description:
The Pharmacy Prior Authorization Technician performs functions as permitted by law, including the initial level processing and review of prior authorization requests for both pharmacy and medical specialty drug reviews. These reviews follow pharmacy management drug policies and procedures. This position accurately prepares and interprets cases for UM (utilization management) reviews and determinations.
In addition, the Technician serves as the content expert for the applications used to process these requests and acts as a resource for staff regarding members’ specific contract benefits. This is consistent with health plan products, policies, procedures, and functions such as member services, claims, and the referral/authorization process.
The Technician provides leadership and expertise in the intake area of the prior authorization process for medications processed through the pharmacy or medical benefit and in processing exception/prior authorization requests that follow standard protocols.
Must have:
Physical and Work Environment Requirements:
Ability to work prolonged periods sitting at a workstation and using a computer.
Ability to sit and/or stand for 3+ hours at a time while using a keyboard, mouse, and/or phone.
Work environment includes standard office settings with fluorescent lighting.
Ability to work from a home office for business continuity.
Ability to travel across the Health Plan’s service region for meetings and trainings as needed.
Must be able to hear, understand, and speak clearly on the phone, with or without a headset.
...then join us in our Destination of Excellence . About the Role TMC Transportation has an immediate full-time opening for a Driver Recruiter working out of our office in Columbia, SC. Hours Monday-Friday 8am-5pm, Saturday rotations 8am-12pm roughly 1-2 Saturdays...
...1. Provide basic first aid and care for minor injuries and illness according to a detailed protocol established by the school nurse (RN) or medical advisor. 2. Administer medication to students according to board policy and district procedures and maintain accurate log...
...Position: Travel Transportation Sourcing Specialist Location: Boulder, CO 80303 3 days onsite, 2 days remote Duration: Fulltime Salary Range: $60-65k Required Skills & Experience Proven experience in supplier sourcing, business development, or operations...
...budgetforourclients.JTWimsattservesbothpublicandprivatesectorclientswitharangeofcommercial,industrial,residential,governmentandspecialtyconstructionprojects. WearecurrentlyseekingaProjectManagerforourSanDiegolocationtop rovide...
...Job Title: Product Engineer IV/ Product Security Solutions Engineering Architect Location: Lake Forest, CA - onsite Contract Length: 12 months with potential to extend. Product Security Solutions Engineering Architect A Product Security Solutions Engineering...