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Express Scripts Prior Authorization Jobs in Tennessee

Clinical Care Technician

Bristol, TN ยท On-site

$16 - $20.75/hr

Obtain prior authorizations/Precerts * Perform EKG's * Referral appt info/trackers * Referrals ... Essential: Communication with others to exchange or express information and ideas. Ability to ...

LPN/RMA/CMA Office Nurse I

Kingsport, TN ยท On-site

$17.25 - $22.50/hr

Obtain prior authorizations and pre-certifications as needed for patients having procedures or ... Essential : Communication with others to exchange or express information and ideas. Ability to ...

Clinical Care Technician

Kingsport, TN ยท On-site

$18 - $23.25/hr

Obtain prior authorizations/Precerts * Perform EKG's * Referral appt info/trackers * Referrals ... Essential: Communication with others to exchange or express information and ideas. Ability to ...

LPN/RMA/CMA Office Nurse I

Kingsport, TN ยท On-site

$17.25 - $22.50/hr

Obtain prior authorizations and pre-certifications as needed for patients having procedures or ... Essential : Communication with others to exchange or express information and ideas. Ability to ...

LPN/RMA/CMA Office Nurse I

Kingsport, TN ยท On-site

$17.25 - $22.50/hr

Obtain prior authorizations and pre-certifications as needed for patients having procedures or ... Essential : Communication with others to exchange or express information and ideas. Ability to ...

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Express Scripts Prior Authorization information

What are the key skills and qualifications needed to thrive in the Express Scripts Prior Authorization position, and why are they important?

To thrive as an Express Scripts Prior Authorization specialist, you typically need a background in pharmacy or healthcare, knowledge of prescription drug protocols, and experience with insurance processes. Familiarity with pharmacy benefit management (PBM) software, electronic health records (EHRs), and prior authorization platforms is important, as are any relevant pharmacy technician certifications. Strong attention to detail, excellent customer service abilities, and effective communication set top performers apart in this position. These skills ensure accurate and timely authorization processing, minimize errors, and support both patient care and pharmacy operations.

What are the main responsibilities of an Express Scripts Prior Authorization specialist on a daily basis?

An Express Scripts Prior Authorization specialist is responsible for reviewing prescription requests, evaluating clinical information, and coordinating with prescribers, patients, and insurance providers to determine coverage eligibility. This role involves managing a high volume of cases, using proprietary systems to document and process authorizations, and frequently communicating via phone and electronic correspondence. Specialists must balance accuracy and efficiency while navigating complex healthcare regulations and helping resolve any issues that arise for patients facing prescription coverage barriers. The position often requires collaboration with pharmacists, physicians, and customer service teams to ensure seamless patient care.

What is an Express Scripts Prior Authorization job?

An Express Scripts Prior Authorization job involves reviewing medication requests to ensure they meet insurance plan requirements before approval. Employees in this role assess prescriptions, follow clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. The job requires attention to detail, knowledge of pharmacy benefits, and strong communication skills. It helps ensure patients receive the most appropriate and cost-effective medications.

What are popular job titles related to Express Scripts Prior Authorization jobs in Tennessee? For Express Scripts Prior Authorization jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Express Scripts Prior Authorization jobs in Tennessee look for? The top searched job categories for Express Scripts Prior Authorization jobs in Tennessee are:

Clinical Care Technician

Holston Medical Group, PC

Bristol, TN โ€ข On-site

$16 - $20.75/hr

Full-time

This job post hasย expired today.ย Applications are no longer accepted.


Job description

Explore opportunities with Holston Medical Group, part of the Optum family of businesses. Holston Medical Group combines the personal feel of a community-based practice with the strength, resources and career opportunities of a leading national health care organization. As a multispecialty clinic offering care across northeast Tennessee and southwest Virginia, our teams deliver highโ€‘quality, valueโ€‘based care that exceeds expectations while making care easier, more affordable and more accessible. Join us and discover the meaning behind Caring. Connecting. Growing together.

General Summary:
Clinical Care Technician will be trained to perform non-invasive clinical patient needs. They will have the opportunity to complete certification as a PCT and BCLS-CPR. The Clinical Care Technician must be able to perform clinical duties in a professional manner as defined by Holston Medical Group standards

Essential Job Functions:

  • Prepare patients for examination
  • Obtain vitals/measurements and document in EHR
  • Dispose of contaminated supplies
  • Assist with UDS collection
  • Nursing checks- expiration dates on samples/meds, O2 tanks, eye wash stations, biohazard room check
  • NST's
  • Autoclave
  • Strong assessment form (documentation in EHR)
  • Sterilizing of medical instruments
  • Ensure that exam rooms are clean and stocked
  • Maintaining supplies and equipment
  • Maintain patient confidentiality
  • Ability to document vital signs appropriately in medical records utilizing computer skills
  • Attend nurse meetings and other educational opportunities as indicated
  • Ability to work in any office as needed
  • Obtain prior authorizations/Precerts
  • Perform EKGโ€™s
  • Referral appt info/trackers
  • Referrals/ordered test completion
  • HIPAA forms
  • School/work excuses
  • No show letters
  • Jury duty notes
  • FMLA/STD forms
  • Chaperone as needed
  • Patient escort
  • Create a task
  • Stock and clean rooms
  • Give normal test results
  • Mail results
  • Customer Service/checking on patients every 10 minutes
  • Change sharps container and biohazard trash
  • Perform Eye Exam (IRIS) and Snellen chart
  • Maintain certification if applicable
  • Maintain CPR certification
  • Other duties as assigned

Environmental/Working Conditions:

Combination of office, exam rooms, diagnostic areas, and other clinical settings. Rare exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to a multi-specialty medical clinic environment.

Qualifications:

  • Education: High School or GED, Required
  • Licensure/Certification: Completion sponsored training program

Physical/Mental Demands:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential:
Communication with others to exchange or express information and ideas. Ability to receive detailed information through oral communication, and to make fine distinctions in sounds. Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations. Remaining upright on the feet, particularly 75% of the time. Moving about on foot to accomplish tasks. Bending body downward and forward by bending spine at the waist and/ or by bending leg and spine. Extending the hands and arms in any direction. Exerting force upon an object so that an object moves away/toward the force. Picking, pinching, typing or otherwise working, primarily with fingers. Applying pressure to an object with the fingers and palm. Perform a variety of duties, often changing from one task to another of a different nature. Perform with frequent interruptions and/ or distractions. Make appropriate job decisions following standard office policies and past precedents. Adjust priorities quickly as circumstances dictate. Ability to establish and maintain cooperative working relationships with co-workers and the public. Ability to interact appropriately with colleagues and patients for different purposes and different context.

Marginal:
Must be able to remain in a stationary position at least 25% of the time. Medium work that includes moving objects up to 50 pounds occasionally. Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. Work independently and identify potentially more effective methods of work operations. Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point. Ability to identify and distinguish colors.

Disclaimer:
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.