Description
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
- Processes prior authorization requests received by phone, fax, or electronically and utilizies 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 maintaines 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 diagosis 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).
Physical Demands
Frequent speaking and listening using a headset, sitting for long periods of time working at a computer, use of hands and fingers across keyboard or mouse, using computer monitors for up to 3 hours without a break.
The physical demands and work environment characteristics described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Required Qualifications
- National Pharmacy Technician certification and applicable 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 - $38.82
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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
