Pharmacy Technician - Prior Authorization - Work From Home

es and supports quality effectiveness of healthcare and Pharmacy Services.

• Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines.

• Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria.

• Determines appropriateness for medications.

• Communicates decision to physicians, physician's office staff, medical management staff, members, and/or pharmacists.

• Will perform clinical research to support request.

• Performs non-medical research including eligibility verification, COB, and benefits verification.

• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

• Process requests in compliance with various laws and CMS regulations and company policies and procedures.

• May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers

• Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services.

• Sedentary work involving significant periods of sitting, talking, hearing, and keying.

• Escalates requests to Pharmacist when request requires extensive clinical review or denial.

Required Qualifications

• National Pharmacy Technician certification (PTCB or ExCPT) and State License, current and in good standing, are required.

• Proficiency in computerized pharmacy systems and software applications.

• Excellent verbal and written communication skills.

• Experience with Windows-based software applications.

• Utilizes various proprietary systems to build, research, process and enter requests.

• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Preferred Qualifications

• High volume call center and production unit.
• Experience in retail, hospital, facility or call center is preferred.

Education

• High School diploma, G.E.D.Pay Range

The typical pay range for this role is:$18.50 - $31.72This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/20/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.