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Pharmacy Technician – Prior Authorizations
CVS Health. Support comprehensive coordination of Medicaid and/or Medicare pharmacy services, including intake and processing of pharmacy authorization requests .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicaid and Medicare pharmacy services coordination, including authorization requests and clinical evaluations. Proficient in maintaining compliance with regulatory requirements and effective communication with healthcare providers.
Highest-signal resume keywords
National Pharmacy Technician CertificationProficiency in Computerized Pharmacy SystemsExcellent Verbal and Written Communication SkillsExperience in High Volume Call CenterKnowledge of CMS Regulations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pharmacy Authorization ProcessingClinical ResearchMedication Appropriateness EvaluationEligibility VerificationBenefits Verification
Soft Skills
Effective CommunicationConfidentiality Adherence
Tools & Technologies
Windows-Based Software ApplicationsProprietary Systems
Certifications & Qualifications
National Pharmacy Technician CertificationHome State License
Industry Keywords
MedicaidMedicarePharmacy ServicesRisk ManagementAccreditation Requirements
About the role
Key responsibilities & impact- Support comprehensive coordination of Medicaid and/or Medicare pharmacy services, including intake and processing of pharmacy authorization requests
- Promote and support quality effectiveness of healthcare and Pharmacy Services
- Evaluate, authorize approval, and communicate decisions for pharmacy requests according to clinical guidelines
- Evaluate and authorize pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria
- Determine medication appropriateness and communicate decisions to physicians, physician office staff, medical management staff, members, and pharmacists
- Perform clinical research to support requests
- Perform non-medical research including eligibility verification, COB, and benefits verification
- Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
- Process requests in compliance with laws, CMS regulations, and company policies and procedures
- Communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies, and Health Care Providers
- Promote internal and external communication to enhance medication therapy management services
- Escalate requests to a Pharmacist when extensive clinical review or denial is required
- Perform sedentary work involving significant periods of sitting, talking, hearing, and keying
Requirements
What you’ll need- National Pharmacy Technician certification and Home State License, current and in good standing, are required
- Proficiency in computerized pharmacy systems and software applications
- Excellent verbal and written communication skills
- Experience with Windows-based software applications
- Experience utilizing proprietary systems to build, research, process and enter requests
- Protects the confidentiality of member information and adheres to company confidentiality policies
- High volume call center and production unit experience preferred
- Experience in retail, hospital, facility or call center preferred
- High School diploma or G.E.D.
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program