Pharmacy Prior Authorization Coordinator II- Remote in VA OR FL!
 Sentara | |
paid time off, tuition reimbursement, 401(k), 403(b)
| |
 United States, Florida, Jacksonville | |
 Jan 30, 2025 | |
|
City/State Tallahassee, FLOverview Work Shift Swing Shift (United States of America) Sentara Health Plans is hiring a Pharmacy Prior Authorization Coordinator II- Remote in VA and FL!Status: Full-time, permanent position (40 hours) Work hours: 8am to 5pm, EST Location: Fully remote in Virginia OR Florida! Job Description Summary:
Required qualifications:
Preferred qualifications:
Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more. Sentara Health Plans is the health insurance division of Sentara Healthcare. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-72594 #Monster Talroo - Health Plan Pharmacy, Managed Care, MCO, Health Plan, Health Care, Prior Authorization, PBM, Benefits, Call center, CPHT, Pharm Tech, Technician, Remote, Virginia, Florida Job Summary Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial). Provides knowledgeable and courteous customer service and response to members and providers. Handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution. Uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/ customer care activities that do not require the expertise of a pharmacist.Serves as a resource and mentor to pharmacy staff and assists TC with workflow oversight for the pharmacy call center and prior authorization operational teams. Assists with special projects and assignments and maintains above average knowledge of all pharmacy related applications to assist in workflow performance. Serves as an internal resource interfacing with members, providers, and internal staff to resolve escalated pharmacy claims and prior authorization issues. Owns the effective resolution of member or provider issues, complaints, and inquiries, focusing on high member satisfaction. 2 years of Pharmacy Call Center or Authorization experience required. 2 years of Managed Care, Health Plan or PBM experience preferred. Qualifications: HS - High School Grad or Equivalent Certified Pharmacy Technician (CPhT) - Certifications - Pharmacy Technician Certification Board (PTCB), Pharmacy Technician Certification (CPhT) - Certification - National Healthcareer Association (NHA) Call Center, Managed Care, Pharmacy TechnicianSkills Active Learning, Active Listening, Communication, Learning Strategies, Microsoft Office, Monitoring, Quality Control Analysis, Reading Comprehension, Service Orientation, Time ManagementSentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment. | |