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Prior Authorization Specialist

Department: Franchise
Location: Providence , RI

Job Title: Prior Authorization Specialist

Reports To: Pharmacist in Charge or Staff Pharmacist on duty


Job Duties Include:


  • Reviewing assigned Prior Authorization cases

  • Obtain clinical information (Medical History, diagnosis and any relevant laboratory reports) necessary to complete the prior-authorization.

  • Review the medical records, diagnosis and laboratory reports.

  • Review Prior Authorization Criteria for medications for Prior Authorization process.

  • Work with insurance plan to pre-certify/authorize the medication

  • Assists with any denied claims to resolve any issues by providing clinical information.

  • Assists with Medication Change Process by providing insurance approved alternatives for prescribed medication.

  • Any other task assigned.


Qualifications:


  • Ability to prioritize and multitask

  • Excellent written and verbal communication skills

  • Strong attention to detail

  • Strong organizational skills


  •  Certificates, Licenses, Registrations At least one of the following:

                 Active unrestricted RPhT MA Pharmacy Technician License

                 Active unrestricted National (CPhT) Pharmacy Technician Certification

  • Education and/or Experience

                High School Diploma or GED


 Benefits:

V-Care Pharmacy offers health insurance, partial paid vacation/ holidays, payouts for unused sick time and soon will be offering 24/7 Telemedicine options for you and your family. We are currently in the process of developing our 401K and dental/vision program.



V-Care Pharmacy is an equal opportunity employer and makes employment decisions on the basis of merit, qualifications and abilities. V-Care Pharmacy prohibits unlawful discrimination based on genetic characteristics or information, race, color, creed, sex, gender, gender identity, marital status, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, sexual orientation or any other consideration made unlawful by federal, state or local laws.


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