Sentara Health Plans is looking to hire Pharmacy Prior Authorization Coordinator 1:
This is a remote position: Remote opportunities available in the following states: Virginia North Carolina Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Washington (state) West Virginia Wisconsin Wyoming
Shift: Monday- Friday from 8:00am to 8:00pm and must be flexible to work on weekends.
The Pharmacy Prior Authorization Coordinator I is responsible for delivering high-quality customer service by answering and managing calls from members provider offices and pharmacies. This role supports the processing of prior authorization (PA) requests for pharmacy benefit medications ensuring accuracy compliance with regulatory and clinical guidelines and alignment with client performance standards. The Coordinator I works under general supervision using established protocols and systems to support timely efficient and accurate PA determinations.
This role uses various business systems and tools to retrieve information analyze requests and enter prior authorization datarequiredfor claims adjudication. The Coordinator Iappliesreasoning skills toidentifyincomplete information and determineappropriate actionsbased on client-specific criteria and clinical protocols (e.g. approvepend refer for clinical decision). The position interacts regularly with internal teams and external stakeholders to ensure consistent high-quality service delivery. Work is performed under general supervision with reliance on documented procedures training and prior experience to guide day-to-day activities.
Key Responsibilities
Verify member insurance eligibility and pharmacy benefit coverage.
Communicate with members and providersregardingbasic pharmacy inquiries and PA status.
Accurately enter and process prior authorization (PA) requests into the system prioritizing appropriately.
Ensure PA requests are processed andfinalizedwithin required turnaround times (TAT) and client Performance Guarantees (PGs) using provided clinical guidelines.
Review medication history and assess for formulary alternatives and tried and failed drugs.
Document all relevant PA information clearly and accurately including approval or denial rationale.
Send PA status updates to providers and pharmacies via fax or other required methods.
Adhere to defined roles and responsibilities related to clinical decision-making boundaries.
Meet or exceed productivity and accuracy targets for PA processing.
Coordinate with members providers and pharmacies to obtain missing information or clarification.
Make outbound calls to gatheradditionalinformation or respond to inquiries related to PAs clinical programs or claim adjudication.
Collaborate with Pharmacy Concierge teams to resolve questions or issues related to PA processing or pharmacy benefits.
Maintain strict confidentiality and security of all member and PA-related data following applicable protocols for data handling and storage.
In addition to the above responsibilities other duties may be assigned.
Education
High School Diploma or GEDstronglypreferred.
Experience
1yearhealthcare experiencerequired.
We provide market-competitive compensation packages inclusive of base pay incentives and benefits. The base pay rate for Full Time employment is: $19.04/HR $31.73/HR. Additional compensation may be available for this role such as shift differentials standby/on-call overtime premiums extra shift incentives or bonus opportunities
Benefits: Caring For Your Family and Your Career
Medical Dental Vision plans
Adoption Fertility and Surrogacy Reimbursement up to $10000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term Short-Term Disability and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance $5250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down $10000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission to improve health every day this is a tobacco-free environment.
For positions that are available as remote workSentara Health employs associates in the following states:
Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Carolina North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin and Wyoming.
Required Experience:
IC
City/StateVirginia Beach VAWork ShiftFirst (Days)Overview:Sentara Health Plans is looking to hire Pharmacy Prior Authorization Coordinator 1:This is a remote position: Remote opportunities available in the following states: Virginia North Carolina Alabama Delaware Florida Georgia Idaho Indiana Kansa...
City/State
Virginia Beach VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is looking to hire Pharmacy Prior Authorization Coordinator 1:
This is a remote position: Remote opportunities available in the following states: Virginia North Carolina Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Washington (state) West Virginia Wisconsin Wyoming
Shift: Monday- Friday from 8:00am to 8:00pm and must be flexible to work on weekends.
The Pharmacy Prior Authorization Coordinator I is responsible for delivering high-quality customer service by answering and managing calls from members provider offices and pharmacies. This role supports the processing of prior authorization (PA) requests for pharmacy benefit medications ensuring accuracy compliance with regulatory and clinical guidelines and alignment with client performance standards. The Coordinator I works under general supervision using established protocols and systems to support timely efficient and accurate PA determinations.
This role uses various business systems and tools to retrieve information analyze requests and enter prior authorization datarequiredfor claims adjudication. The Coordinator Iappliesreasoning skills toidentifyincomplete information and determineappropriate actionsbased on client-specific criteria and clinical protocols (e.g. approvepend refer for clinical decision). The position interacts regularly with internal teams and external stakeholders to ensure consistent high-quality service delivery. Work is performed under general supervision with reliance on documented procedures training and prior experience to guide day-to-day activities.
Key Responsibilities
Verify member insurance eligibility and pharmacy benefit coverage.
Communicate with members and providersregardingbasic pharmacy inquiries and PA status.
Accurately enter and process prior authorization (PA) requests into the system prioritizing appropriately.
Ensure PA requests are processed andfinalizedwithin required turnaround times (TAT) and client Performance Guarantees (PGs) using provided clinical guidelines.
Review medication history and assess for formulary alternatives and tried and failed drugs.
Document all relevant PA information clearly and accurately including approval or denial rationale.
Send PA status updates to providers and pharmacies via fax or other required methods.
Adhere to defined roles and responsibilities related to clinical decision-making boundaries.
Meet or exceed productivity and accuracy targets for PA processing.
Coordinate with members providers and pharmacies to obtain missing information or clarification.
Make outbound calls to gatheradditionalinformation or respond to inquiries related to PAs clinical programs or claim adjudication.
Collaborate with Pharmacy Concierge teams to resolve questions or issues related to PA processing or pharmacy benefits.
Maintain strict confidentiality and security of all member and PA-related data following applicable protocols for data handling and storage.
In addition to the above responsibilities other duties may be assigned.
Education
High School Diploma or GEDstronglypreferred.
Experience
1yearhealthcare experiencerequired.
We provide market-competitive compensation packages inclusive of base pay incentives and benefits. The base pay rate for Full Time employment is: $19.04/HR $31.73/HR. Additional compensation may be available for this role such as shift differentials standby/on-call overtime premiums extra shift incentives or bonus opportunities
Benefits: Caring For Your Family and Your Career
Medical Dental Vision plans
Adoption Fertility and Surrogacy Reimbursement up to $10000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term Short-Term Disability and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance $5250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down $10000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance Legal Resources Plan Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission to improve health every day this is a tobacco-free environment.
For positions that are available as remote workSentara Health employs associates in the following states:
Alabama Delaware Florida Georgia Idaho Indiana Kansas Louisiana Maine Maryland Minnesota Nebraska Nevada New Hampshire North Carolina North Dakota Ohio Oklahoma Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin and Wyoming.
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