Clinical Prior Authorization Technician (Temp, Temp-to-hire)

2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting

Experience handling prior authorization requests/understanding of prior authorization requirements required

National Certified Pharmacy Technician (CPhT) license, required

High school diploma or the equivalent; Associate’s or bachelor’s degree is preferred

Excellent communication, writing, and organizational skills

Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment

Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines

Make outbound calls to providers to obtain additional clinical information to ensure substantial clinical information exists to reach a clinical determination for pharmacist review

Proactively obtains clinical information from prescribers, referral coordinators, and appropriate staff to ensure all aspects of clinical guidelines are addressed for pharmacist review.

Review and analyze pharmacy claims data for proactive outreach and intervention.

Identify, document, and escalate provider concerns to the appropriate internal team including various members of the Prior Authorization Team

Triage phone calls from members, pharmacy personnel, and providers by asking applicable drug and client specific clinical questions.