ZipRecruiter

Log In

1

Express Scripts Prior Authorization Jobs in Tennessee

next page

Showing results 1-20

All JobsExpress Scripts Prior Authorization JobsExpress Scripts Prior Authorization Jobs in Tennessee

Express Scripts Prior Authorization information

What skills are needed for Express Scripts careers?

Candidates for Express Scripts positions typically need strong communication, problem-solving, and customer service skills. Knowledge of healthcare or pharmacy operations, attention to detail, and proficiency with computer systems or pharmacy management software are also important. Certifications such as pharmacy technician licensure may be required for certain roles.

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 the lawsuit against Express Scripts?

There have been lawsuits filed against Express Scripts related to allegations of antitrust violations and unfair business practices. These legal actions typically involve claims from competitors or healthcare providers and are handled through the judicial system. Job seekers should stay informed about ongoing legal issues that could impact company operations or reputation.

Does Express Scripts do prior authorization?

Express Scripts, as a pharmacy benefit manager, often requires prior authorization for certain medications to ensure appropriate use and coverage. The process involves healthcare providers submitting documentation for approval before dispensing specific drugs. Job roles related to prior authorization typically involve reviewing medical information and coordinating with healthcare providers to process these requests.

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 the typical Express Scripts salaries?

Salaries for roles at Express Scripts vary depending on the position, experience, and location. Entry-level positions such as pharmacy technicians typically earn around $15 to $20 per hour, while more experienced roles like pharmacy managers or data analysts can earn between $60,000 and $100,000 annually. Benefits often include health insurance, retirement plans, and opportunities for professional development.
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:
Express Scripts Prior Authorization jobs near you
Office Nurse I - with IV Certification

Office Nurse I - with IV Certification

Holston Medical Group

Kingsport, TN • On-site

$18.23 - $26.36/hr

Full-time

Re-posted 2 days ago

Holston Medical Group rating

6.7

Company rating: 6.7 out of 10

Based on 20 frontline employees who took The Breakroom Quiz

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 high-quality, value-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.
Pay Range: $18.23 - $26.36
General Summary:
The Office Nurse is responsible for providing quality, compassionate patient care in the clinic setting consistent with Holston Medical Group's quality practice standards, polices, procedures and customer service expectations. As a member of the clinical staff, the Office Nurse will proactively participate in identifying the needs of the patients and will implement methodology as directed to improve both patient clinical experience and care. Duties include but are not limited to: taking vital signs, data collection with both written and electronic documentation, and medication administration. The Office Nurse is also one of the patient's primary sources of Health Education in the Patient-Centered Medical Home Health Care Delivery Model.
Main Responsibilities:
  • Use patient first values in assisting patients with needs
  • Greet patients with compassion and a friendly face
  • Accurately assess and record patient vital signs in electronic database
  • Prepare patients for examinations
  • Serve as a Health Educator as directed in the Patient-Centered Medical Home Health Care Delivery Model
  • Obtain prior authorizations and pre-certifications as needed for patients having procedures or tests
  • Dispose of contaminated supplies/used items
  • Sterilize medical instruments as needed
  • Ensure that exam rooms are clean and stocked for patient use
  • Maintain both supplies and equipment, proactively work with co-workers to stock
  • Attend nurse meetings and other educational opportunities
  • May be moved to other offices upon request based upon the business need of Holston Medical Group on an occasional basis
  • Pick up vaccines and other medications as needed
  • Mail normal labs to patients and call patients with abnormal labs
  • Perform customer service checks on patients every 10 minutes
  • Change sharps container and biohazard trash
  • Ensure to follow policies and procedures set by Holston Medical Group
  • Maintain communication with providers to ensure that patents needs are taken care of
  • Communicate all office issues with the Nurse Manager and Regional Operations Manager
  • Ensure that equipment is in operating order (crash cart, defibrillator, autoclave, etc.)
  • Mentor new nursing staff and orient to the office
  • Ensure that the Health Department records are maintained for the vaccinations for children
  • Maintain clinical area to meet site visit standards
  • Maintain strict confidentiality in all matters relating to personnel and patient PHI (Protected Health Information)
  • Enroll patients in myHMG as directed
  • Direct Colon Screening

Education/Experience/Knowledge:
  • High School diploma or equivalent required
  • LPN license by the state in which employed
  • 0 -2 years LPN experience
  • Active IV Certification Required
  • CPR certified
  • Must possess excellent communication skills
  • Ability to work in a team environment and collaborate with others

Key Competencies:
  • Compassion
  • Customer Focus
  • Ethics and Values
  • Learning on the Fly
  • Functional/Technical Skills
  • Problem Solving
  • Informing

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.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

What Holston Medical Group employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply