About the Company
CVS Health is a leading healthcare innovation company, dedicated to helping people on their path to better health. We’re a diversified health services company with more than 300,000 employees, including 40,000 physicians, pharmacists, nurses and nurse practitioners. Through our health plans, pharmacies and various health services, we are committed to transforming the healthcare experience and providing a more connected and accessible approach to care.
Job Description
We are seeking a dedicated and detail-oriented Managed Care Pharmacy Technician to join our team in an office-based setting in Evanston, IL. This role is crucial in supporting our managed care operations by processing prior authorizations, managing medication claims, and ensuring compliance with benefit plans. The successful candidate will play a vital role in coordinating with healthcare providers, pharmacists, and members to facilitate appropriate and timely access to medications. This is an excellent opportunity for a motivated individual to contribute to a dynamic healthcare environment and grow their career with a company that values its employees and offers comprehensive benefits.
Key Responsibilities
- Process prior authorization requests for prescription medications according to established guidelines and procedures.
- Communicate effectively with prescribers' offices, pharmacies, and members to gather necessary information and provide status updates.
- Review and interpret member benefit plans to ensure accurate processing of claims and medication approvals.
- Assist pharmacists and other healthcare professionals with medication therapy management activities.
- Maintain accurate and complete documentation of all interactions and transactions in designated systems.
- Adhere to all HIPAA regulations and company privacy policies.
- Identify and escalate complex issues to appropriate clinical staff or supervisors.
- Participate in quality improvement initiatives and team meetings.
- Manage incoming calls and inquiries related to pharmacy benefits and authorizations.
Required Skills
- High School Diploma or GED.
- Certified Pharmacy Technician (CPhT) certification from PTCB or NHA.
- Minimum of 1 year of experience as a Pharmacy Technician, preferably in a managed care, retail, or hospital setting.
- Proficiency in pharmacy software systems and Microsoft Office Suite (Word, Excel, Outlook).
- Excellent communication and interpersonal skills.
- Strong attention to detail and organizational abilities.
- Ability to work independently and collaboratively in a fast-paced office environment.
- Knowledge of prescription drug names, dosages, and common medical terminology.
- Understanding of insurance benefit structures and prior authorization processes.
Preferred Qualifications
- Associate's Degree or higher in a related field.
- Experience with prior authorization processing.
- Familiarity with managed care organizations (MCOs) and pharmacy benefit managers (PBMs).
- Experience in customer service roles within healthcare.
Perks & Benefits
- Comprehensive health, dental, and vision insurance plans.
- 401(k) retirement plan with company match.
- Paid time off and company holidays.
- Tuition reimbursement and continuing education opportunities.
- Employee wellness programs and discounts.
- Career development and growth opportunities within a large healthcare organization.
- Life and disability insurance.
- Employee assistance program.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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