Prior Authorization Specialist

SUMMARY:

Under general supervision of the clinical pharmacy team, this full-time position is responsible for the support of pharmacy team initiatives related to pharmacy utilization of medications prescribed for the patients of Lowell Community Health Center.  The Prior Authorization Specialist assists the clinical pharmacy team and provides the day to day support for the prior authorization program.

SPECIAL DUTIES AND RESPONSIBILITIES:

·         Review and summarize applicable clinical information as part of the prior authorization submission process.
·         Submit documented physician and patient information as part of the prior authorization submission process.
·         Assist with data entry and monitoring/researching patient health records for prior authorization requests and ad hoc reports.
·         Obtain and disseminate information concerning prior authorization requests.
·         Provide real time information to patients and/or health care professions regarding the prior authorization submission process.
·         Participate in quality improvement initiatives and in-service programs as requested.

·         Assist with disease management initiatives. Work with other members of the clinical pharmacy team in conjunction with providers to optimize patient outcomes.
·         Maintain collaborative, team relationships with peers and colleagues in order to effectively contribute to the working groups, achievement of goals, and to help foster a positive work environment.
·         Perform other similar and related duties as required or directed.

QUALIFICATIONS:

- Graduation from high school or equivalent.
- Registered pharmacy technician with the Massachusetts Board of Registration in Pharmacy.
- Nationally certified with Pharmacy Technicians Certification Board (PCTB) and be in good standing.
- Minimum 1-2 years of retail, drug utilization review, or physician office management experience or 2 years of hospital experience required. Previous experience with the prior authorization process is preferred. 

JOB KNOWLEDGE AND SKILLS:

·         Demonstrates understanding and commitment of mission and values of the health center
·         Relationship-building skills to foster effective working relations across the health center.
·         Experience in prior authorization submission process.
·         Superior communication skills.
·         Knowledge of integrated health networks.
·         Knowledge of health plan drug formularies.
·         Project and resource management skills.
·         Creative thinking and problem solving skills.
·         Ability to understand importance of and respect for the confidentiality of all patient information in accordance with applicable standards and regulations.
·         Proficiency in Microsoft Office applications, including Access, Excel, PowerPoint and Word.

Physical Requirements:

1. Frequent sitting, standing, and walking.
2. Some lifting, pushing or pulling required up to 25 pounds.
3. Ability to perform CPR (chest compressions).

WORK ENVIRONMENT:

Frequent contact with patients, families, visitors, nurses and other department staff. Occasional requests to change work areas to cover another priority area to meet patient needs. Occasional stress and pressure caused by multiple simultaneous demands. May be exposed to various body fluids and/or infectious diseases.  Universal precautions and techniques are included in orientation and the availability of protective wear is supported and encouraged when the employee is at risk for exposure. Travel as deemed appropriate.

BENEFITS:

Lowell Community Health Center offers a competitive salary with an excellent benefits program; including sick, personal and paid holidays, health insurance, company paid life and long term disability, 403B, & flexible spending accounts.