Job Summary:

Review and evaluate outpatient take-home medications to assure the appropriateness and medical necessity of medication use based on established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations. Ensure completion of activities that maximize revenue capture for high-cost medications.

Conduct prospective prior authorization services to expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance paperwork issues.

Improve patient service experience and Upstate Medical University Hospital retail pharmacy revenue through provision of prior authorization services at Upstate Medical University Hospital clinics.

Observe and understand prescribing trends within Upstate University Hospital clinics to identify areas for improved specialty pharmacy contracting.

Develop an effective working relationship with external entities.

Refer appropriate patients to the Medication Assistance Program (MAP). Identify self-pay patients eligible for enrollment into the MAP and coordinate enrollment with the MAP staff. 

Work location may vary to any Upstate pharmacy location within Onondaga County based on operational need.

Minimum Qualifications:

Four (4) years of experience in a similar prior authorization role required. Will also consider candidates with an Associates Degree and 2 years experience in a similar prior authorization role. Excellent written/oral communication, interpersonal, organizational, conflict resolution, and computer skills required. 

Preferred Qualifications:

Experience with medication reimbursement, medications, physician orders and insurance claim submission preferred. Experience with healthcare insurance prior authorization/coding and performing insurance carrier/managed care review preferred.  National Pharmacy Technician Certification preferred. LPN preferred.  

Work Days:

Rotating schedule between 8am-6pm. Weekends and holidays based on operational need

Message to Applicants:

Recruitment Office: Human Resources