Kelly® is seeking a Pharmacy Prior Authorization Technician to work at a top insurance client in the vibrant Rochester, NY area. Let us help you grow at work and discover the next step in your career, all while being a vital part of your community
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Salary/Pay Rate/Compensation: $20.50/hour

Summary Description:

The Pharmacy Prior Authorization Technician provides essential functions that encompass initial level processing and review of prior authorization requests. These requests include both pharmacy and medical specialty drug reviews, utilizing pharmacy management drug policies and procedures. Responsibilities include preparing and interpreting cases for UM reviews and determination, acting as a content expert for processing applications, and serving as a resource regarding members’ contract benefits.

Essential Responsibilities/Accountabilities:

Level I:

• Conduct medication prior-authorization and necessity reviews.
  

• Route cases directly to the pharmacist/medical director for final determination.
  

• Issue verbal and written member notifications as required.
  

• Review and interpret prescription and medical benefit coverage.
  

• Develop and implement process improvements for efficiency.
  

• Communicate with providers, clinical pharmacists, and internal staff.
  

• Act as a lead troubleshooter for the pharmacy help desk and customer care.
  

• Ensure appropriate authorization entry across all lines of business.
  

• Perform system testing for upgrades/enhancements to care management systems.
  

• Provide phone coverage for incoming calls related to UM processes.
  

• Support drug pricing queries using online resources.
  

• Maintain knowledge of health plan contracts and procedures.
  

• Produce and distribute information, track, and report department performance.
  

• Participate in interdepartmental coordination and communication.
  

• Maintain high standards of integrity and privacy according to corporate policies.
  

• Perform other functions as assigned by management.

Minimum Resource Qualifications:

All Levels:

• High school diploma required; Associates degree preferred.
  

• Minimum two years’ experience in health-related field.
  

• Pharmacy Technician certification (CPhT), LPN, or Medical Assistant/Technologist background preferred.

Physical Requirements:

• Ability to work prolonged periods sitting at a workstation.
  

• Ability to work while sitting/standing and using a computer/phone for extended hours.
  

• Typical office environment including fluorescent lighting.
  

• Ability to work in a home office for business continuity.
  

• Ability to travel for meetings and/or training as needed.
  

• Strong verbal communication skills.

What happens next:

• Once you apply, you’ll proceed to next steps if your skills and experience look like a good fit. But don’t worry—even if this position doesn’t work out, you’re still in our network.
  

• That means all of our recruiters will have access to your profile, expanding your opportunities even more.

Helping you discover what’s next in your career is what we’re all about, so let’s get to work.
Apply to be a Pharmacy Prior Authorization Technician today!

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