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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
Sentara Health Plans is hiring a Pharmacy Prior Authorization Coordinator II- Remote in VA and FL!
Status: Full-time, permanent position (40 hours)
Work hours: 8am to 5pm, EST
Location: Fully remote in Virginia OR Florida!
Job Description Summary:
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Under the direction of a Pharmacy Team Coordinator (TC), the Pharmacy Prior Authorization Coordinator II (PAC II) is responsible for supporting the day-to-day operations for the call center and prior authorization cases for all lines of business (Medicaid, Medicare, Exchange and Commercial).
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Provides knowledgeable and courteous customer service and response to members and providers.
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Handles member/provider requests/inquiries regarding pharmacy benefits, prior authorizations, or claim resolution.
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Uses the pharmacy computer system to facilitate prior authorizations and participate in patient/provider/ customer care activities that do not require the expertise of a pharmacist.
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Serves as a resource and mentor to pharmacy staff and assists TC with workflow oversight for the pharmacy call center and prior authorization operational teams.
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Assists with special projects and assignments and maintains above average knowledge of all pharmacy related applications to assist in workflow performance.
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Serves as an internal resource interfacing with members, providers, and internal staff to resolve escalated pharmacy claims and prior authorization issues.
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Owns the effective resolution of member or provider issues, complaints, and inquiries, focusing on high member satisfaction.
Required qualifications:
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2 years of Pharmacy Call Center or Authorization experience REQUIRED
Preferred qualifications:
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2 years of Managed Care, Health Plan or PBM experience preferred
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Certified Pharmacy Technician (CPhT) – Certifications – Pharmacy Technician Certification Board (PTCB)/ National Healthcareer Association (NHA)
Benefits: Sentara offers an attractive array of full-time benefits to include
Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.
Sentara Health Plans is the health insurance division of Sentara Healthcare.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.
With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-72594
#Monster
Talroo – Health Plan
Pharmacy, Managed Care, MCO, Health Plan, Health Care, Prior Authorization, PBM, Benefits, Call center, CPHT, Pharm Tech, Technician, Remote, Virginia, Florida
When you join Sentara in a clinical role, you become part of an interdisciplinary team that is passionate about quality care. Our diverse inpatient and outpatient settings offer the tools and technologies you need to do your best work. All while learning and growing within a culture that embraces opportunity.
Culture In Action
At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work are what make Sentara special and what allows us to deliver excellent service and care to our patients, members, and communities.
Sentara prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
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