About the Company
Optum, a part of UnitedHealth Group, is a leading health services innovation company committed to helping people live healthier lives and making the health system work better for everyone. We combine technology, data, and expertise to improve care delivery, lower costs, and create a more efficient healthcare experience. Our SaaS platforms are at the forefront of transforming administrative processes, including vital prior authorization workflows, for providers and payors nationwide.
Job Description
We are seeking a dedicated and detail-oriented Prior Authorization Pharmacy Tech with a strong focus on SaaS platforms to join our innovative team in Torrance, CA. In this hybrid role, you will play a crucial part in streamlining the prior authorization process for specialty medications, utilizing our advanced proprietary software solutions. You will work closely with healthcare providers, insurance companies, and patients to ensure timely approval of necessary treatments, contributing directly to patient care and operational efficiency. This position requires a proactive individual comfortable navigating complex pharmaceutical guidelines and adept at leveraging technology to optimize workflows.
Key Responsibilities
- Process prior authorization requests for pharmacy services and specialty medications accurately and efficiently using our SaaS platform.
- Communicate with prescribers, pharmacies, and insurance companies to obtain necessary documentation and clarify information.
- Review and interpret complex medical records, drug policies, and insurance guidelines to determine authorization eligibility.
- Monitor the status of prior authorization requests and follow up as needed to ensure timely resolution.
- Maintain accurate and detailed records of all communications and prior authorization activities within the system.
- Identify and escalate complex or problematic cases to pharmacists or other clinical staff as appropriate.
- Provide exceptional customer service to all stakeholders, resolving inquiries and concerns related to prior authorizations.
- Contribute to the continuous improvement of prior authorization processes and our SaaS platform by providing feedback.
Required Skills
- Current Pharmacy Technician license/certification in the state of California.
- 1+ years of experience in prior authorization processing, preferably in a specialty pharmacy or managed care setting.
- Proficiency in using software-as-a-service (SaaS) platforms and electronic health records (EHR) systems.
- Strong understanding of medical terminology, drug names, and pharmaceutical guidelines.
- Excellent written and verbal communication skills.
- Demonstrated ability to work independently and manage a high volume of tasks with keen attention to detail.
- Problem-solving skills and a proactive approach to issue resolution.
- Ability to adapt to new technologies and processes quickly.
Preferred Qualifications
- Associate's degree in a related field.
- Advanced certification (e.g., CPhT).
- Experience with specific prior authorization software solutions (e.g., CoverMyMeds, Surescripts, or proprietary systems).
- Familiarity with various insurance plans and their prior authorization requirements.
- Experience working in a fast-paced, technology-driven healthcare environment.
Perks & Benefits
- Comprehensive medical, dental, and vision insurance plans.
- 401(k) retirement plan with company match.
- Paid time off (PTO) and company holidays.
- Tuition reimbursement and professional development opportunities.
- Employee assistance program.
- Life and disability insurance.
- Wellness programs and resources.
- Hybrid work model offering flexibility.
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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