CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Pharmacy Technician - Prior Authorization
Location
MST (UTC-7)
Posted
10 days ago
Salary
$19 - $35 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Pharmacy Technician - Prior Authorization
CVS Health
Role Description - 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, members, 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 hour 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 should be hard wired with Ethernet cord). - Candidate must have a secure workspace/office in their home. - Candidate must have high level skill with working with a PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens). Qualifications - National Pharmacy Technician certification and state licensure or applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained. - Between 0-5+ years of Pharmacy Technician 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. - Prior Authorization processing experience. - Claims processing experience. - Managed Care, Medicare, and/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. Benefits - 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. - Additional details about available benefits are provided during the application process and on Benefits Moments.
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Role Description This serves as an approved standardized functional statement (FS) for Pharmacy Technician, GS-07, to be used throughout the Veteran Health Administration (VHA) Veterans Integrated Service Network (VISN) Clinical Contact Centers without modification. Major Duties: - Works collaboratively with VISN programs, services, and interdisciplinary team members to provide access to care and meet the needs of Veterans, their family members, and/or legal representatives via various contact modalities including: - Telephone calls - Secure messaging - Chat - Text messaging - Video - Addresses a broad range of topics including medication refills and renewals, basic billing inquiries, and procedural pharmacy activities. - Routinely reviews computer medication profiles for: - Therapeutic duplication - Prescription non-compliance - Allergies - Drug interactions - Seeks assistance from a Clinical Pharmacist or supervisor for further evaluation when needed. - Processes and submits patient requests for new prescription orders and renewal requests, including controlled substances, accurately and in a timely manner. - Uses approved VISN Clinical Contact Center Pharmacy protocols to satisfy patient medication requests. - Documents patient contact and resolution in VISN Clinical Contact Center software and/or the Electronic Health Record (EHR), including: - What was requested - What action was taken - Any other pertinent information for future research - Assists in the documentation of medication variances. - Assists in training for lower graded technicians and technician students. - Assists in the completion of workload for other VISN Clinical Contact Center Pharmacy Services during: - Natural disasters - Low staffing - Other contingency needs Qualifications - Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. - Basic Requirements: - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Education or Experience: - (1) None required. - (2) For all grade levels and positions that accept both education and experience to qualify, equivalent combinations of qualifying education and experience that total at least 100% are qualifying. - Certification: For positions above the full performance level, the employee must pass a national certification exam and hold an active national certification through either: - (1) Pharmacy Technician Certification Board (PTCB), Certified Pharmacy Technician (CPhT). - (2) National Healthcareer Association (NHA), Certified Pharmacy Technician (ExCPT). Requirements - Pharmacy Technician GS-7 Experience: Candidates must possess one year of experience equivalent to the next lower grade level. - Certification: For positions above the full performance level, the employee must pass a national certification exam and hold an active national certification through either: - (a) PTCB as a CPhT. - (b) NHA as an ExCPT. - Knowledge, Skills and Abilities (KSAs): - (a) Knowledge of pharmacy technician principles, practices, concepts, and theories providing for sound independent work. - (b) Knowledge of the computerized prescription process and input of prescriptions and medication orders or electronic equivalent. - (c) Ability to resolve pharmacy/medication issues with other members of the healthcare team, Veterans, and external customers. - (d) Ability to train developmental pharmacy technicians and students. - (e) Ability to dispense medication or sterile products following all regulations, policies, and procedures to ensure safe medication distribution. - (f) Ability to troubleshoot automated dispensing equipment (ADE) or technology platforms/databases. Physical Requirements - Work is primarily sedentary but may involve prolonged standing and/or walking.
• Optimize patient outcomes through telephonic interventions • Focus on the tactical execution of medication management services, including polypharmacy, adherence, and pharmacotherapy optimization • Counsel patients via telephonic outreach on medication adherence, address any medication related problems such as adherence barriers, polypharmacy, or high risk medication use, and make appropriate evidence-based recommendations to patients and Practice Care Teams • Perform focused clinical chart reviews as needed to inform patient interventions • Obtain and document patient commitment to medication adherence and address barriers in real time • Escalate complex clinical cases to prescribers or interdisciplinary teams as appropriate • Meet and sustain performance goals (e.g., STARs, HEDIS) • Collaborate with Physicians, clinical and administrative staff to optimize the Medication Management workflow and patient experience • Proactively identify gaps in medication management through patient interactions and translate patient insights into targeted recommendations that drive improvements in practice operations and clinical workflows • Participate in the design, implementation, and evaluation of pilot programs or process changes (“test and learn”) within the outreach model • Serve as a clinical subject matter expert, leveraging clinical pharmacy expertise to support organizational objectives and adapt to evolving healthcare needs • Develop and maintain standardized resources, educational tools, and clinical protocols to support improved medication outcomes and performance on quality measures (e.g., STARS, HEDIS) for practices, clinicians, and patients
Tennessee Preferred Drug List Pharmacist
UnitedHealth GroupUnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
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Mail Order Pharmacy Technician
CenterWellCenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. Cares for patients with chronic and complex illnesses. Offers personalized clinical and educational services to improve health outcomes and drive superior medication adherence. CenterWell, a Humana company, creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and the fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional, and social wellness of our patients. Part of Humana Inc. (NYSE: HUM). Offers stability, industry-leading benefits, and opportunities to grow yourself and your career. Employs more than 30,000 clinicians committed to putting health first. Provides flexible scheduling options, clinical certifications, leadership development programs, and career coaching.
Role Description The Mail Operations Pharmacy Technician 2 accurately fills and counts medications. The Mail Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative, operational, and customer support assignments. - Perform computations. - Typically work on semi-routine assignments. - Ensure inventory levels are adequate for dispensing by working with the inventory supply team. - Make decisions focused on interpretation of area/department policy and methods for completing assignments. - Work within defined parameters to identify work expectations and quality standards. - Have some latitude over prioritization/timing and work under minimal direction. - Follow standard policies that allow for some opportunity for interpretation/deviation and independent discretion. Qualifications - Must have an active license with the Board of Pharmacy in the appropriate state. - Minimum 1-2 years of pharmacy experience. - Must be passionate about contributing to an organization focused on improving consumer experiences. Requirements - Self-provided internet service must meet the following criteria: - Minimum download speed of 25 Mbps. - Minimum upload speed of 10 Mbps. - Wireless, wired cable, or DSL connection is suggested. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - Occasional travel to Humana's offices for training or meetings may be required. Benefits - Medical, dental, and vision benefits. - 401(k) retirement savings plan. - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave). - Short-term and long-term disability. - Life insurance. - Many other opportunities for personal wellness and smart healthcare decisions. Pay Range The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc. $40,000 - $52,300 per year

