Express Scripts Prior Authorization Jobs in Forney, TX

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!
JOB SUMMARY
Complete prior authorizations and refill authorizations for ambulatory care clinics across the system.
 

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

JOB DUTIES

• Ambulatory Clinical Pharmacy Technician (ACT) responsibilities may include:
  1. Promote patient care, safety, and medication adherence through the processing and/or assistance of prior authorizations, refill authorizations, and patient assistance programs
  2. Completes tasks in EMR as directed
  3. Participate in teaching activities, including but not limited to, precept Pharmacy Technicians, Pharmacy Students, Pharmacists, and Nurses regarding refill authorizations, prior authorizations, and or patient assistance programs
  4. Report directly to the pharmacist on service in the clinic and/or to other pharmacists while working
  5. Responds to calls and questions in an efficient, effective, and professional manner
  6. Serves as a pharmacy services representative in addition to valuable member of the healthcare team
  7. ACT will assume additional duties as required by the pharmacy director, manager, and/or supervisor
• Prior Authorization activities may include:
  1. Initiate and coordinate prior authorization requests in the electronic health record and/or external processing system (e.g. CoverMyMeds)
  2. Act as a liaison between the Clinical Department and members, providers, pharmacies, and internal departments and respond to inquiries regarding status of prior authorization requests
  3. Assist with internal and external reporting requests and summarize internal program statistics
  4. Maintain prior authorization management solution, including:
     a. Interpretation and application of prior authorization guideline revisions
     b. Configuration and quality assurance of clinical criteria, decision scenarios, and other elements
     c. Development and maintenance of notification templates in compliance with client plan language and other regulatory requirements
  5. Compare prescription claims data against requested parameters and summarize/present results or recommendations
• Prescription Refill Authorization activities may include:
  1. Utilize authorized physician protocol to process prescription refill requests in a timely manner and documents into EMR system
  2. Conduct patient and pharmacy callbacks in a time efficient manner while maintaining proper phone etiquette
  3. Handle intake of multiple phone lines using established scripts, protocols and service processes
  4. Accurately track and enter calls using appropriate documentation, reporting, and database applications. Assist with maintaining department databases and resource tools
• Patient Assistance Program (PAP) activities may include:
  1. Coordinate administrative aspects of medication services pertaining to patient assistance programs (PAP)
  2. Provides support necessary to facilitate the application and acquisition of free or reduced cost medications
  3. Serves as a liaison between patients and clinic medical staff regarding eligibility, application procedures, submission of required documentation, and prescription of medications
  4. Maintains comprehensive data base in conjunction with clinic leadership

SECURITY AND EEO STATEMENT
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.