Pharmacy Authorization Specialist
2 weeks ago
Realistic Job Preview Video
Optum is a worldwide organization dedicated to delivering healthcare solutions, leveraging technology to assist millions in achieving better health. Your contributions will directly enhance health outcomes by connecting individuals with essential care, pharmacy benefits, data, and resources they require to thrive. Here, you will discover a culture rooted in diversity and inclusion, skilled colleagues, comprehensive benefits, and opportunities for career advancement. Make a meaningful impact on the communities we serve as you help us promote health equity on a global scale.
The primary responsibilities of a Pharmacy Technician in Prior Authorization include providing expert customer service support to members, clients, and healthcare providers. This role is essential for processing incoming requests for prior authorizations related to both formulary and non-formulary medications, all while ensuring exceptional customer service and optimizing productivity. Requests may be received via fax or telephone from healthcare providers and pharmacists.
This position involves conducting clinical reviews for authorizations in accordance with legal and contractual obligations, including but not limited to turnaround times (TATs) and service level agreements (SLAs). All interactions with callers must be documented in compliance with contractual and various regulatory/legal requirements.
For those residing in select states, there is flexibility to work remotely while tackling challenging tasks. Responsibilities include:
- Handling prior authorization inquiries through inbound calls (up to 50 to 70 calls daily) from providers and members, as well as researching and resolving formulary and benefit-related issues using appropriate reference materials.
- Processing authorizations through various computer systems while adhering to job aids, policies, and procedures to ensure data accuracy and necessary updates.
- Prioritizing patient safety and quality of work, maintaining a secure workspace, and communicating with leadership when safety concerns arise.
- Resolving issues and complaints promptly.
- Gathering member data during inbound phone requests to facilitate pharmacist consultations.
- Participating in a 5-week training program, typically scheduled from 8:00 AM to 5:00 PM local time, Monday through Friday.
- Shifts following training will be 8 hours long with a 1-hour lunch break, with availability required from 5:00 AM to midnight.
- Potential for scheduled overtime and holiday work based on business needs.
- Maintaining a secure workspace/office at home.
Benefits include:
- Accrued Paid Time Off starting with the first pay period, plus 8 Paid Holidays and a Floating Holiday.
- Medical plan options, including participation in a Health Spending Account or Health Savings Account.
- Dental, Vision, Life & AD&D Insurance, along with Short-term and Long-term Disability coverage.
- 401(k) Savings Plan and Employee Stock Purchase Plan.
- Education reimbursement and Employee Assistance Program.
- Flexible work arrangements and voluntary benefits (pet insurance, legal insurance, LTC insurance, etc.).
At Optum, our mission is to help individuals lead healthier lives and enhance the health system for everyone. We are committed to addressing barriers to good health that disproportionately affect marginalized groups and those with lower incomes. Our focus on diversity fosters a healthier environment: Optum is an Equal Employment Opportunity/Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum maintains a drug-free workplace.
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