Job details
Job type full-time
Full job description
We enjoy the important work we do every day on behalf of our members.
Job summary
Under the direction of the supervisor, pharmacy utilization management, the pharmacy utilization management (um) coordinator senior is responsible for setting up and processing cases in the various applications for drug prior authorization (pa) requests.
Job description
Upon set up and processing of pa requests, the pharmacy coordinator senior will run test claims once authorizations are approved and reach out to members and providers as necessary.
Additional tasks include performing daily quality checks to ensure compliance, managing the pharmacy um team email box, responding to provider inquiries, managing electronic prior authorization (epa) requests, submitting process improvements, among others.
**note: job is currently 100% remote/home office based, but candidates will be required to commute to the canton office location later this yearThis is a hybrid position requiring a minimum of two days in the canton office per week.
Requirements
Education:
High school diploma or ged
Associate’s degree in healthcare, nursing, or a related area or equivalent experience.
Certified pharmacy technician (cpht)
Experience:
Minimum of 3+ years of pharmacy experience, preferably in managed care setting or pbm.
Software/database experience- mhk, rxclaims, and cas or other database/software experience is preferred
Proficient in ms office-excel, word, and powerpoint preferred
Skill requirements:
Ability to prioritize work when processing pharmacy pa requests per guidelines and within specific turnaround timeframes.
Ability to process high volumes of requests with great accuracy.
Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment.
Good working knowledge of medical terminology.
Must be able to work independently, and as part of a teamRegular interface with various levels of staff and management is required as well.
Must be able to exercise appropriate judgment as necessary.
Working conditions and additional requirements
Fast paced office environment handling multiple demandsOpen cubicle work setting with a personal computer.
Travel required on an as needed basisSome early mornings, evenings, weekends, or extended work day may be required or as program dictatesMust have flexibility with work schedule.
Confidential data: all information (written, verbal, electronic, etc.) that an employee encounters while working at tufts health plan is considered confidentialExposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
What we build together changes our customer`s health for the betterWe are looking for talented and innovative people to join our teamCome join us!
