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.
Position Summary
- Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews.
- Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation.
- Reviews potential prior authorization denial language to ensure NCQA requirements are met.
- Follows prior authorization workflow, policies, and procedures during the course of the workday.
- Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions.
- Maintains a balance of productivity, quality and timeliness of work.
- Participates in training and continuing education as required.
- Participates in team/departmental meetings as required.
- Excellent attendance is a must.
- Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions.
- Successful pharmacy technicians will possess good written and verbal communication skills.
Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00am to 7:00pm (may vary by time zone). Pharmacy Technicians work 8 hours shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not guaranteed. Work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary. Rotating weekend schedule may be required.
Candidate must have their own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord). Candidate must also have a secure workspace/office in their home. Candidate must have high level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens).
Required Qualifications
- National Pharmacy Technician certification and Arizona State Pharmacy Technician license, current and in good standing, are required and must be maintained
- Between 1-5+ years of Pharmacy Prior Authorization processing experience
- Ability to Multi-task and prioritize work
- Ability to adjust based on business or department needs
- Good organization skills
Preferred Qualifications
Retail or Hospital experience
Managed Care or Medicaid experience
AS400 experience
Proficiency in using computerized resources and software applications
Proficiency with Microsoft applications (Excel, Word, and Outlook)
Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information
Working knowledge of drug dosage forms, drug strength, generic and brand name equivalent.
Education
High School diploma, G.E.D.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $35.29
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full?time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well?being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
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