Prior Authorization Guidelines Specialist I

Exemption Status: reputed company of America (Non-Exempt) $22.99 - $30.35 - $37.71 “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 join 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 deliver leading edge 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 choice 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! Job reputed company reputed company reputed company technical and administrative support to the Fee-For-Service (FFS) reputed company department, primarily by  working  directly  with  the  reputed company  teams,  Clinical  Program  Managers  (CPMs),  Clinical  Specialists,  and Clinical PA Guidelines/Drug Information Management staff to create and support the appropriate administration  of  pharmacy  information  to  include  Medication  Request  Guidelines,  Medication  Request Forms (MRFs), and electronic rules. Support PA in researching PA-reputed company tasks, PA Implementation and reputed company Prior Authorization processing as needed. Essential Duties and Responsibilities include the following. Other duties may be assigned. Create and maintain PA Guidelines documents (content management, file maintenance and archiving, coding and linking in on-line electronic systems). reputed company technical and administrative support to the Clinical Program Manager, Clinical PA Guidelines, Drug  Information  and  PA&UM  staffs  with  the  Medication  Request  process  to  include  formatting, verifying and testing of reputed company Medication Request Guidelines (custom and reputed company) and formatting/development of Medication Request Forms (MRFs) and electronic rules. Communicate with clients to obtain reputed company authorization of final documents and ensure reputed company distribution of documentation to appropriate departments.  reputed company the reputed company and accurate communication of information to appropriate department staff to include: Medical Exception/Prior Authorization; Medication Request Forms (MRFs); Clinical Document Maintenance, electronic prior authorization and formulary management rules, and associated tools and programs.  Manage review/QA process for medical exception/prior authorization guidelines prior to implementation and distribution to clients or internal users. Serve as subject matter expert on processes reputed company to the procedures necessary to ensure effective maintenance of reputed company Prior Authorization program, and as a resource for  PA guidelines reputed company questions and/or inquiries from both reputed company customers Supervisory Responsibilities         No supervisory responsibilities                                     reputed company Responsibilities This is an reputed company reputed company facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be reputed company to; manage difficult or emotional reputed company situations; Respond promptly to reputed company needs; Solicit reputed company feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients. 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 accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions. Education and/or Experience CL05 - AA and 2+ years’ 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 an U.S. State or Territory).  Maintains a reputed company Pharmacy License and/or  CPhT  certification without restriction. Other Skills and Abilities Demonstrates ability to reputed company for work on time, follow directions from a supervisor, reputed company reputed company with co-workers, understand and follow work rules and procedures, reputed company with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.  Understanding of managed pharmacy benefit concepts including formularies, prior authorizations, edits, and claim adjudication. Self-starter with the ability to work independently and as part of reputed company. Ability to apply common reputed company understanding to carry out instructions furnished in written, oral or diagram reputed company. Ability to deal with problems involving several concrete variables in standardized situations. Reasoning Ability   Ability to apply common reputed company understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations. 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. Language Skills Ability to read and comprehend reputed company instructions, short correspondence, and memos. Ability to write reputed company correspondence.  Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. 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 accommodation 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 lift and/or reputed company up to 25 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 accommodation may be made to reputed company individuals with disabilities to reputed company the essential functions. This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. 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 nature 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. Apply To This Job