Prior Authorization Pharmacy Specialist I

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WHY JOIN FCS

At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages.

Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance.

A LITTLE BIT ABOUT FCS

Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence.  With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network.  Utilizing innovative clinical research, cutting-edge technologies, and advanced treatments, we are committed to providing world-class cancer care.  We are recognized by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to ground-breaking therapies, in a community setting, and may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the majority of new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval.

Through our partnership with Sarah Cannon, we are one of the largest clinical research organizations in the United States. Often, FCS leads the nation in initiating research studies and offering ground-breaking new therapies to patients.

Come join us today!

Summary:

The Prior Authorization Specialist is responsible for performing prior authorizations and appeals for oral oncology and supportive medications as an extension of the FCS medical practice. The Prior Authorization Specialist will interact with patients, caregivers, and healthcare providers regarding inquiries for prescription status. The specialist will assist the pharmacy staff and other health care professionals in supporting prescription processing to ensure prompt service and quality patient care.

PRIMARY TASKS AND RESPONSIBILITIES:

• Demonstrates effective communication skills and premier customer service to successfully interact with all levels of internal and external parties to convey information correctly.
• Performs clinical reviews of patients’ charts using appropriate criteria to complete prior authorizations.
• Process appeals for prior authorization denials according to specific insurance plan requirements, provides documentation and composing a letter of medical necessity as appropriate.
• Obtain prior authorization approvals utilizing online authorization sites (ex: Eviti, New Century Health, Cover My Meds) and prior authorizations via fax and phone.
• May require interpretation or clinical data deviation from standard procedures.
• Escalate complex clinical concerns to the appropriate clinician with a goal of first call resolution.
• Comply with all accreditation standards, federal and state laws and regulations pertaining to patient privacy, patient’s rights, personnel law, safety, labor, and employment law. Adhere to Company and departmental policies and procedures, including IT, HR, and compliance policies and procedures and Disaster Recovery Plan.
• Participate in the pharmacy’s Continuous Quality Improvement (CQI) program by identifying and reporting quality related events.
• Additional tasks as needed to support the team and FCS. 

EDUCATION/CERTIFICATIONS & LICENSES:

• A high school diploma or GED Required
• Active Registered Florida Pharmacy Technician license and state of residence is required.
• Active National Pharmacy Technician Certification is required.
• Prior Authorization Certified Specialist (PACS) certification preferred.

EXPERIENCE:

• Pharmacy benefit prior authorization experience preferred.
• Minimum three (3) years’ experience working in a health care or customer service-related field, preferably pharmacy or call center required.
• Hematology/oncology experience preferred.

CORE COMPETENCIES, KNOWLEDGE/SKILLS/ABILITIES:

Essential competencies and KSAs targeted to successfully performing in role:

• Analysis & Critical Thinking
• Strong interpersonal skills to include effective verbal and written communication
• Solid time management with the ability to prioritize multiple tasks
• Ability to collaborate across various levels of management, departments and teams
• Comfortable negotiating problems and exploring solutions with physician population

VALUES:

• Patient First – Keeping the patient at the center of everything we do
• Accountability – Taking responsibility for our actions
• Commitment & Care – Upholding FCS vision through every action
• Team – Working together, one team, one mission

Expectations for all Employees

Every FCS employee is expected to regularly conduct themselves in a professional and respectful manner, to comply with all labor laws, workplace policy and workplace practices.  Employees are expected to bring issues of any forms of workplace harassment, discrimination, or other potential improprieties to the attention of their management or the human resources department. 

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SCREENINGS – Background and drug screens

Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. All offers of employment at Florida Cancer Specialists & Research Institute are contingent upon clear results of a thorough background screening. Additionally, as a condition of employment, FCS requires all new hires to receive various vaccinations, including the influenza vaccine, barring an approved exemption. In addition, FCS is a drug-free workplace, and all new hires will be subject to drug testing. Medical Marijuana cards are not recognized.

EEOC

Florida Cancer Specialists & Research Institute (FCS) is committed to helping individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. If you require an accommodation to submit a resume for positions at FCS, please email FCS Recruitment (Recruiter@FLCancer.com) for further assistance. Please note this email address is intended to request an accommodation as part of the application process. Any other correspondence will not receive a response.

FCS is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

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