- Processes prior authorization requests received by phone, fax, or electronically and utilizies various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews
- Proactively completes prior authorization approvals and denials that are due to expire and maintaines complete, timely, and accurate documentation
- Reviews potential prior authorization denial language to ensure NCQA requirements are met
- Follows prior authorization workflow, policies, and procedures during the course of the workday
- Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions
- Maintains a balance of productivity, quality and timeliness of work
- Participates in training and continuing education as required
- Participates in team/departmental meetings as required
- Excellent attendance is a must
- Successful pharmacy technicians will be proficient in drug name and diagosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions.
-Successful pharmacy technicians will possess good written and verbal communication skills- Hours of operation for Aetna Pharmacy Prior Authorization are between 5:00am to 7:00pm (may vary by timezone). Pharmacy Technicians work 8 hours shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not gauranteed
- Rotating weekend schedule is required- Candidate must have their own home internet access (internet can be hard wired with Ethernet cable)
- Candidate must also have a secure workspace/office in their home
- Candidate must have high level skill with working with PC (ex. using mouse and keyboard, accessing and navigating through multiple systems and screens)Work schedule is approximate and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including on weekends and holidays. Part time positions are not available. Position requires the ability to work extended hours when necessary.Physical Demands: Frequent speaking and listening using a headset, sitting for long periods of time working at a computer, use of hands and fingers across keyboard or mouse, using computer monitors for up to 3 hours without a break.The physical demands and work environment characteristics described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Required Qualifications
- National Pharmacy Technician certification(PTCB, NHA/ExCPT) current and in good standing is required and must be maintained.

- State Board of Pharmacy license not required due to renewal requirement restrictions
- Between 1-5+ years of Pharmacy Prior Authorization processing experience (retail or hospital experience may be considered in lieu of prior authorization experience)
- Ability to multi-task and prioritize work
- Ability to adjust based on business or department needs
- Good organization skills

Preferred Qualifications
- Retail or Hospital experience
- Managed Care or Medicaid experience
- AS400 experience
- Proficiency in using computerized resources and software applications
- Proficiency with Microsoft applications (Excel, Word, and Outlook)
- Knowledge in pharmacy practices, procedures, and ability to read and understand clinical information
- Working knowledge of drug dosage forms, drug strength, generic and brand name equivalent.

Education

- High School diploma, G.E.D.Pay Range

The typical pay range for this role is:$18.50 - $31.72This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/03/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.