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Oscar Health // health insurance
 
Tempe, Arizona, United States    Posted: Thursday, September 09, 2021
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Pharmacy Technician Prior Authorizations to join our Clinical Review Team. 

Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role:

You will play an essential role in building our pharmacy utilization management function. The Clinical Review team is one of Oscars most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. 

You will be responsible for understanding & helping to grow our pharmacy utilization management program.  You will drive high quality reviews & support our Pharmacists & Doctors in all aspects of the review process.

You will report into the Pharmacy Clinical Review Team Lead. This is a remote role, you will work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities:

  • Determining eligibility & screening incoming pharmacy prior authorization requests for all required documents
  • Preparing, organizing, & distributing pharmacy prior authorization requests for review by pharmacist/physician & responding to pharmacist/physician requests for additional information
  • Learning & using Oscar & vendor tools to create, process, & properly track pharmacy prior authorization requests
  • Collecting relevant medical information (via telephone, fax, & portal) & applying the appropriate PA criteria
  • Clearly documenting all communication & decision-making, ensuring a peer could easily reference & understand your decision
  • Taking inbound calls from providers regarding prior authorizations as well as outbound calls to providers to communicate approval status or request more information.

Requirements:

  • 2+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager
  • Active, unrestricted Pharmacy Technician certification (CPhT) 
  • In-depth understanding of how to operationalize step therapy rules & regulations
  • High School degree or equivalent GED

Bonus points:

  • Bachelors degree
  • Experience working with Caremarks portal & criteria
  • Experience working remotely

COVID-19 vaccine requirements for in-person work: 

To protect the health & safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. 

If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices (either full-time or part-time), employees conducting sales work in the field & employees conducting at-home or in-person visits with members.

 
 
 
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