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.
- 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.
- 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
- 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 email@example.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.