Sr. Pharmacy Authorization Specialist

Responsibilities The Sr. Pharmacy Authorization Specialist serves as a senior coordinator of Prominence Health Plan’s prior authorization review process. This position will assist the Manager of Clinical Pharmacy Services in developing, refining, and improving the prior authorization review process for injectable drugs. This includes training new hires (pharmacist and pharmacy technicians) on the prior authorization review process, creating training materials and policies/workflow documents, working with other departments and vendors to improve the authorization platform, auditing of nonclinical and clinical reviewers’ work, interfacing with government bodies during CMS Program and URAC accreditation audits, etc. This position will administratively and clerically assist the Manager of Clinical Pharmacy Services and Director of Pharmacy with managing the Prominence’s Pharmacy and Therapeutics Committee. Will serve in the authorization workflow queue by preparing and loading prior authorizations for injectable drugs. This includes ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose and frequency of submitted requests. In addition, this individual will perform provider outreach to obtain sufficient documentation for coverage determinations as necessary. By performing these duties, the Pharmacy Authorization Specialist will coordinate an effective and efficient review process, improving the internal workflow of the pharmacy team and increasing member and provider satisfaction with our prior authorization review process. Qualifications Qualifications and Requirements: Bachelor’s degree in health care, business management, or related field preferred National Pharmacy Technician Certification through PTCB 10+ years in retail, long term care, specialty, home infusion, mail order pharmacy 3+ years in managed care pharmacy with prior authorization workflow Understanding of medical drug billing process and possesses the ability to interpret clinic notes and/or drug orders Ability to effectively communicate in English, both verbally and in writing. Knowledge of medical terminology Exceptional customer service skills, interfacing between the health plan and providers’ offices Ability to identify process improvement opportunities Proficient in Microsoft Office (Word, Excel, Outlook) Enjoys working in both individual and team settings Comfortable calculating doses and frequencies for medication treatment regimens Self-starter, resourceful and able to execute projects in a fluid and fast paced environment Strong analytical skills Knowledge of the purpose and process of prior authorizations Attention to detail and accuracy Ability to utilize technology and work within multiple software programs Understanding of health plan departments and functional areas for problem resolution Comfortable collecting and tracking performance metrics and reports EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.