Prior Authorization Specialist II, Pharmacy Services CFHP
3 weeks ago
Full Time
12238 Silicon Drive
Allied Health
Day Shift
POSITION SUMMARY/RESPONSIBILITIES:
Prepares pharmacy prior authorization requests for review by nurse/pharmacist/physician reviewers. Completes pharmacy authorization requests and issues review outcome notifications to Community First Health Plans (CFHP) members and providers. Follows clinical criteria and instructions to approve prior authorization requests based on established criteria, plan policies and procedures. Performs non-medical research including eligibility verification and benefits verification. Reviews medication utilization reports and identifies trends through advanced data analytics. Produces reports to comply with regulatory and accreditation standards.
EDUCATION/EXPERIENCE
Graduation from high school/GED required. Bachelor's degree preferred. Five years of pharmacy experience required. Some coursework at the college level is preferred. Excellent customer service, phone etiquette, attention to detail, and typing skills is required. Basic knowledge of Microsoft Office and internet required. Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired. Knowledge of InterQual screening criteria as well as DRG, ICD-10 and CPT coding is preferred.
LICENSURE/CERTIFICATION
Texas State Board of Pharmacy registration required. Certification as a Pharmacy Technician (CPhT) is required.
-
Pharmacist Pop Hlth Mgmt CFHP
4 weeks ago
San Antonio, United States University Health System Full timeFull Time 12238 Silicon Drive Professional Non-Nursing Day Shift POSITION SUMMARY/RESPONSIBILITIES Responsible for the administration of pharmaceutical services to CFHP members for all lines of business. Implements decisions set forth by the CFHP Pharmacy & Therapeutics Committee. Evaluates medication utilization and prior authorization requests for...
-
Authorization Specialist II
33 minutes ago
San Antonio, United States Deans Professional Services Full timeJob DescriptionJob DescriptionDean’s Professional Services is now hiring a qualified, patient-care-focusedAuthorization SpecialistIIto work in a Hospital Facility inthe Texas area. – RemoteWe are on a mission to create care that’s more convenient and professional. With solutions that are value-based and patient-centered. To accomplish this, we are...
-
Nurse Case Manager
2 weeks ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of...
-
Nurse Case Manager
22 hours ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of...
-
Nurse Case Manager
1 day ago
San Antonio, TX, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of...
-
Nurse Case Manager
4 weeks ago
San Antonio, TX, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of...
-
Authorization Specialist
1 month ago
San Antonio, United States TSAOG Orthopaedics & Spine Full timeJob DetailsLevel Entry Job Location Annex - San Antonio, TX Position Type Full Time Education Level High School Salary Range $16.00 Hourly Travel Percentage None Job Shift Day Job Category Health Care DescriptionGet to know us: TSAOG Orthopaedics and Spine is a large multi-specialty physician group. We have been here since 1947 and were not going anywhere....
-
San Antonio, United States Saint Luke's Hospital Full time**Up to $2,500 Sign On Bonus available based on experience** The **Registered Pharmacy Tech II** assists in preparing, packaging, delivering and charging of medications under the supervision of a licensed pharmacist. **MINIMUM EDUCATION**: High School Graduate or equivalent; accredited training in sterile products preparation. **MINIMUM EXPERIENCE**:...
-
Service Cooridnator
2 weeks ago
San Antonio, United States University Health System Full timeFull Time 12238 Silicon Drive Clerical Day Shift POSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator-Non-Clinical (SC-NC) supports medical, behavioral, and social support staff within the Service Coordination team to provide a holistic evaluation of STAR Kids Members' individual dynamics, needs and preferences while providing education and...
-
Compliance Specialist
3 weeks ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES The Compliance & Regulatory Specialist is responsible for assisting in the oversight and execution of compliance in the health plan’s operational areas, including delegated operational activities and regulatory reporting. The candidate must be familiar with current Texas Medicaid regulations, the Texas Department of...
-
Pharmacy Liaison
4 weeks ago
San Antonio, United States University Health System Full time4502 Medical Dr. Allied Health Rotating Shifts POSITION SUMMARY/RESPONSIBILITIES The Meds to Beds (MTB) Technician is responsible for enrolling patients into the bedside medication delivery program. In addition, the Meds to Beds technician will coordinate the filling, delivery, counseling, and billing of prescriptions to the patient's rooms prior to...
-
Pharmacy Liaison Inpatient
4 weeks ago
San Antonio, United States University Health System Full timeFull Time 903 W. Martin Allied Health Rotating Shifts POSITION SUMMARY/RESPONSIBILITIES The Meds to Beds (MTB) Technician is responsible for enrolling patients into the bedside medication delivery program. In addition, the Meds to Beds technician will coordinate the filling, delivery, counseling, and billing of prescriptions to the patient's rooms prior...
-
Pharmacy Liaison
4 weeks ago
San Antonio, United States University Health System Full timeFull Time 4502 Medical Dr. Allied Health Rotating Shifts POSITION SUMMARY/RESPONSIBILITIES The Meds to Beds (MTB) Technician is responsible for enrolling patients into the bedside medication delivery program. In addition, the Meds to Beds technician will coordinate the filling, delivery, counseling, and billing of prescriptions to the patient's rooms...
-
Pharmacy Technician PT
7 hours ago
San Francisco, United States Alto Pharmacy Full timeJob DescriptionJob DescriptionAlto Pharmacy is a full-service, digitally-powered pharmacy that makes it simple to live your healthiest life by providing an easier, more supportive and more affordable pharmacy experience. We're redefining what a pharmacy can do, with fast and reliable prescription delivery, tools like treatment reminders and medication...
-
Service Coordinator
1 week ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator-RN/NP/PA (SC-RN/NP/PA) provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being, independence, integration in the community, and potential for productivity. The...
-
Service Coordinator
1 month ago
San Antonio, United States University Hospital Full timeService Coordinator (RN)Full Time 12238 Silicon Drive Nursing Day Shift POSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator - Registered Nurse provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being,...
-
Pediatric Pharmacy Manager
1 week ago
San Antonio, United States Texas Nursing Services Full timeJob DescriptionJob Description👩️⚕️ Pediatric Pharmacy Clinical Manager Opportunity in San Antonio, TX💰 Salary range from $113,165 to $166,976 annually, plus a 10% leadership bonus.✈️ Case-by-case relocation assistance and sign-on bonus.Position Overview:We are seeking a Pediatric Pharmacy Clinical Manager for a full-time position with no...
-
Pediatric Pharmacy Manager
7 hours ago
San Antonio, United States Texas Nursing Services Full timeJob DescriptionJob DescriptionTitle: "Pediatric Pharmacy Clinical Manager - Leading Healthcare Facility in San Antonio, TX"Salary: $54.43 - $80.20/hour with a 10% leadership bonus.Introduction: Join our Hospital, a cornerstone of healthcare excellence, as our next Pediatric Pharmacy Clinical Manager. In this pivotal role, you'll be at the forefront of...
-
Service Coordinator
7 days ago
San Antonio, United States University Hospital Full timeService Coordinator (RN)Full Time 12238 Silicon Drive Nursing Day Shift POSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator-RN/NP/PA (SC-RN/NP/PA) provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being,...
-
Field Service Engineer II
9 hours ago
San Antonio, United States Omnicell Full timeJob DescriptionField Service EngineerJoin Omnicell, a pioneering force in healthcare technology, as a Field Service Engineer (FSE) I or II, where your work will directly impact patient care and outcomes. Our FSEs provide troubleshooting, repair services, and scheduled preventive maintenance for Omnicell's pharmacy and supply automation solutions at customer...