Offer summary

Qualifications:

Bachelor's degree in Business or a related health care field, or four years of relevant work experience., Certified Pharmacy Technician and Licensed Pharmacy Technician required., Strong verbal and written communication skills, along with managed care customer service experience., Proficiency in word processing, spreadsheets, and database software, with Microsoft Excel experience preferred..

Key responsabilities:

Conduct clinical reviews of prior authorizations using Smart UM Clinical.

Review medical policy for high dollar infusion and injections within the medical benefit division.

Proactively reach out to provider offices to gather additional information for prior authorization reviews.

Maintain the prior authorization review process to meet required turnaround times.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

Primary responsibility for the Pharmacy Operations Representative will be conducting the clinical review of prior authorizations using Smart UM Clinical. This position is responsible for reviewing medical policy for high dollar infusion and injections within the medical benefit division. The individual is also responsible for proactive outreach to provider offices to gather additional information and maintaining the process for prior-authorization review within a timely manner to meet plan required turnaround times.

Job Requirements:

Bachelors degree in Business or a related health care field or four years work experience in a health care/insurance industry (or equivalent)
Certified Pharmacy Technician required
Licensed Pharmacy Technician required
Verbal and written communication skills
Managed care customer service experience
Demonstrated proficiency of word processing spreadsheets and database software
Drug information skills
Handle multiple tasks and strong organizational skills
Microsoft excel experience strongly preferred
Microsoft Outlook and Team experience preferred

Additional Job Details:

Work Schedule: Monday - Friday any 8-hour shift between the hours of 7:00am-6:00pm MST
Rotating Weekends are required, typically twice a year
This is a Telecommute (Remote) role: Must reside within 250 miles of the office locations listed
Sponsorship: Sponsorship is not available

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.