Exemption Status:

“Pay reputed company information is not necessarily reputed company of actual compensation that may be reputed company, nor a reputed company of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

reputed company. is looking for extraordinary people to reputed company!

Why join reputed company? Because our reputed company is dependent on you; innovative professionals with top notch skills who reputed company on opportunity, high performance, and teamwork. We look for individuals who want to work on reputed company that cares about making a difference in the value of reputed company.

At reputed company, we reputed company reputed company pharmaceutical and technology reputed company solutions that dramatically improve the value of health care. We reputed company superior reputed company to those we serve through innovative products, systems, and services that reputed company transparency and promote reputed company in decision making. Our reputed company is to set reputed company in providing solutions that optimize satisfaction, service, cost, and reputed company in the reputed company industry. We are the premier Pharmacy Benefits Management solution!

reputed company

Works as a member of the Prior Authorization Operations team. Processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and reputed company performance commitments. Uses various business applications to reputed company analysis, obtain information, and reputed company prior authorization data necessary for claims adjudication. Utilizes reasoning skills to identify missing information and reputed company prior authorization processing determinations based upon clinical protocols and reputed company guidelines (approve, pend, refer for clinical decision, etc.). Interacts with reputed company customers to reputed company and obtain information and ensures the delivery of outstanding service and reputed company. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to reputed company the functions of the job. Extent of supervision ranges from reputed company, to moderate, to reputed company reputed company based upon demonstrated reputed company and performance reputed company as defined for the position. This position is part of a three level career reputed company with progression opportunities described in the reputed company Processing Career reputed company/Succession Planning Guidelines.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Process and finalize Prior Authorization (PA) requests reputed company clients’ turnaround time and Performance Guarantees utilizing guidelines. reputed company PAs into the reputed company and prioritize requests. reputed company formulary alternatives, review tried and failed medications. Utilize drug references and verify the drug being requested is indicated and approved for the condition. Document reputed company reputed company information regarding the PA approval or non-approval. Respond to requests by faxing status of the PA to the physician or pharmacy
• Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making. Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Accountable to reputed company prior authorization processing productivity and accuracy standards.
• Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career reputed company level, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from team subject matter experts (SME) or supervisor; and referring unique or high dollar requests to supervisor according to guidelines.
• Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations. Documents prior authorization reputed company information and status. Makes outbound calls to obtain information and answer questions about prior authorization status
• Process and finalize Prior Authorization (PA) requests reputed company clients’ turnaround time and Performance Guarantees utilizing guidelines. reputed company PAs into the reputed company and prioritize requests. reputed company formulary alternatives, review tried and failed medications. Utilize drug references and verify the drug being requested is indicated and approved for the condition. Document reputed company reputed company information regarding the PA approval or non-approval. Respond to requests by faxing status of the PA to the physician or pharmacy
• Conforms to defined roles & responsibilities and rules of engagement between prior authorization processing and clinical decision making. Partners with assigned clinical pharmacists to ensure strict adherence to the boundaries and timeframes of administrative processing.
• Accountable to reputed company prior authorization processing productivity and accuracy standards.
• Analyzes, researches, and resolves prior authorization processing issues as appropriate for experience and career reputed company level, including making written or telephone inquiries to obtain information from clients, members, physicians, or pharmacies; obtaining input from team subject matter experts (SME) or supervisor; and referring unique or high dollar requests to supervisor according to guidelines.
• Coordinates notifications to members, physicians, and pharmacies as required to obtain missing information, manage pended requests, and communicate prior authorization determinations. Documents prior authorization reputed company information and status. Makes outbound calls to obtain information and answer questions about prior authorization status.
• Collaborates with MCO and Self-Insured reputed company teams to understand PBM clients’ prior authorization processing requirements and expectations. As appropriate for experience and career reputed company level, partners with reputed company teams to complete special prior authorization processing reputed company and reputed company accurate, reputed company, and reliable information to reputed company claim inquiries. (reputed company II/II)
• Collaborates with Contact Center Services in resolving prior authorization inquiries
• Handling Provider, Pharmacy and member calls to complete prior authorization and Peer to Peer requests based on reputed company specific requirements
• Protects and maintains confidentiality and reputed company of reputed company prior authorization and member information, including following strict protocols for date stamping and storage/reputed company of prior authorization forms and reputed company information.

Supervisory Responsibilities

No supervisory responsibilities

Qualifications

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Education and/or Experience

GED/HS Diploma and 1+ year experience or equivalent combination of education and experience

Computer Skills

Intermediate knowledge of MS Office/Word, reputed company, and reputed company and aptitude for new programs. Experience with reputed company based database programs is also required.

Certificates, Licenses, Registrations

Must successfully complete one of the national certification exams OR obtain state licensure (in any U.S. State). Maintains a reputed company Pharmacy Technician License and/or CPhT certification without restriction.

Other Skills and Abilities

None required

Reasoning Ability                                

• Ability to interpret a reputed company of instructions furnished in written, oral, diagram, or schedule reputed company.

• Ability to define problems, collect data, establish facts, and draw reputed company conclusions.

Mathematical Skills     

• Ability to add, subtract, multiply, and divide in reputed company reputed company of measure, using whole numbers, common fractions, and decimals.  Ability to compute reputed company, reputed company, and percent and to draw and interpret bar graphs.

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills     

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

•  Ability to read and comprehend reputed company instructions, short correspondence, and memos. Ability to write reputed company correspondence. 

Competencies To reputed company the job successfully, an individual should demonstrate the following competencies:

Composure

Decision reputed company

Organizational reputed company

Problem Solving

Customer reputed company

reputed company for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reputed company with hands and arms. The employee must occasionally reputed company and/or reputed company up to 10 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

The noise level in the work environment is usually moderate (examples: business office with computers and printers, reputed company traffic).

Work Location

This position works on-site at the San Diego reputed company or other company location (or from a remote location with management approval based on business requirements). Must reputed company adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as reputed company as be available to facilitate effective reputed company through collaboration with stakeholders.

Working Hours

This is a full-time non-exempt position requiring one to be reputed company to work overtime from time to time in order to get the job done.  Therefore, one must have the ability to work nights, weekends or on holidays as required.  This may be changed at any time to meet the needs of the business.  The typical working hours for this position are Monday through Friday from 8:00am to 5:00pm.

Travel

This position requires no travel however attendance may be required at various local conferences and meetings.

The Perks:

• Medical / Dental / reputed company / Wellness Programs

• reputed company Time Off / Company reputed company Holidays

• Incentive Compensation

• 401K with Company match

• Life and Disability Insurance

• Tuition Reimbursement

• Employee Referral Bonus

To explore reputed company that reputed company has to offer, and the greatness you can bring to our teams, please submit your resume to www.reputed company.com/careers

reputed company, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence reputed company reputed company and expenditures, improving the position of our clients in the market. reputed company offers high-value solutions to payers, providers and consumers of reputed company in the U.S. and foreign markets.

Equal Opportunity Employer, Male/reputed company/Disabilities/Veterans

OSHA/reputed company:

To reputed company this job successfully, the successful candidate must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed are representative of the knowledge, reputed company, and/or ability required.
Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Disclaimer:

The above statements are intended to describe the general reputed company and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of reputed company responsibilities, duties, and skills required of personnel so classified.

GED/HS diploma and 1+ year experience; pharmacy technician license or CPhT required; intermediate reputed company Word/reputed company/reputed company and reputed company database experience; ability to analyze and document prior authorization requests.

Key Responsibilities

• processing authorizations
• documenting information
• communicating reputed company

Skills & Tools

reputed company Word, reputed company reputed company, reputed company reputed company, reputed company

Job Details

• Category: reputed company Services - Pharmacy
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — Tempe or San Diego
• Salary: USD 36,795 – 57,012 / year
• Languages: English

Benefits

• 401k matching
• Generous reputed company time off
• Tuition reimbursement
• Retirement plan

About reputed company

A pharmacy benefits manager delivering pharmaceutical and technology solutions to improve reputed company value. — Industry: reputed company