Role Description

• Processes prior authorization requests received by phone, fax, or electronically and utilizes 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 maintains 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 diagnosis 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 8:30pm (may vary by time zone). Pharmacy Technicians work 8 hours shifts that may fall in between these hours of operations. Overnight shifts may also be available, but not guaranteed. 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.
• Rotating weekend schedule may be required.
• Candidate must have their own home internet access with minimum speed of 100mbps download (internet can be hard wired with Ethernet cord).
• 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).

Qualifications

• National Pharmacy Technician certification and Arizona or applicable state Pharmacy Technician license, current and in good standing, are required and must be maintained.
• Between 1-5+ years of Pharmacy Prior Authorization processing 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.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range The typical pay range for this role is: $18.50 - $35.29. This 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.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.