Pharmacy Operations Representative - Clinical Review Job Listing at HCSC in Albuquerque, NM (Job ID R0042578)

Description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Primary responsibility for the Pharmacy Operations Representative will be conducting the clinical review of prior authorizations using Smart UM Clinical. This position is responsible for reviewing medical policy for high dollar infusion and injections within the medical benefit division. The individual is also responsible for proactive outreach to provider offices to gather additional information and maintaining the process for prior-authorization review within a timely manner to meet plan required turnaround times.

Job Requirements:

• Bachelors degree in Business or a related health care field or four years work experience in a health care/insurance industry (or equivalent)
• Certified Pharmacy Technician required
• Licensed Pharmacy Technician required
• Verbal and written communication skills
• Managed care customer service experience
• Demonstrated proficiency of word processing spreadsheets and database software
• Drug information skills
• Handle multiple tasks and strong organizational skills
• Microsoft excel experience strongly preferred
• Microsoft Outlook and Team experience preferred

Additional Job Details:

• Work Schedule: Monday - Friday any 8-hour shift between the hours of 7:00am-6:00pm MST
• Rotating Weekends are required, typically twice a year
• This is a Telecommute (Remote) role: Must reside within 250 miles of the office locations listed
• Sponsorship: Sponsorship is not available

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Compensation: $37,400.00 - $78,400.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards

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