Express Scripts Prior Authorization Jobs in Forney, TX

The Associate Care Navigator will conduct case management on behalf of the client and Southern Scripts ensuring specialty drug spend trend management savings in accordance with client agreement. This position will solution for lowest cost drug while working in a high touch member centric manner, establishing a member relationship as a single point of contact. The Associate Care Navigator will provide targeted, personalized service based on a holistic view of the member, benefits, health information, and engagement. This may include site of service transitions and all other RxCompass component saving methods. This may include both medical and PBM claims. Member engagement would include telephone, written correspondence, fax, or app. Member engagements are typically non-routine and may require deviation from standard screens, scripts, and procedures to engage, consult, and educate members and providers by delivering individualized programs based upon the member’s unique needs and preferences. Key areas of focus include, but not be limited to:

• Utilizes resources to assist members in understanding components of Southern Scripts products including claims, accumulators, usage, balances, and cost sharing.
• Support the success of Southern Scripts and our clients through the development, presentation, and implementation of member-centric solutions that drive down the cost of specialty medications, while maintaining a positive member experience.
• Supports department and client requirements in the meeting of turnaround times by working as needed to ensure all referrals are handled with a focus on a timely specialty drug service solution.
• Provides support in meeting client expectations regarding efficiency, service levels, privacy maintenance, and quality of decision-making.
• Responsible for maintaining compliance with ERISA, HIPAA, and client specific requirements.
• Works as part of the team to meet business unit objectives. Expects and accepts work in an environment where change agility is fundamental to success.
• Ability to deal with a diverse customer base in a friendly manner, including medical and pharmacy office providers, hospitals, members, home infusion providers and other vendors inclusive of our drug cost saving efforts.
• Must display empathy and effective listening skills to deliver successful cost savings transitions of care.
• The ability to balance compassion, integrity, discretion, and sound judgement, with a strong desire to achieve and exceed expected metric.
• A proven background in medical/pharmacy benefits, particularly as these relate to specialty medications.
• Respect work rules and procedures.
• Acts as an advocate for change.
• Abide by all obligations under HIPAA related to Protected Health Information (PHI).
• If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
• Flexibility to understand, appreciate and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Supervisory Responsibility

None

• Full-time, hourly/non-exempt position.
• Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00AM to 5:00PM CT. We cover clients from West to East Coast, work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends and holidays pursuant with industry demands, although this would not be typical.

This position could require overnight travel from remote location.

Our benefits package is designed to keep our employees happy and healthy - physically, mentally and financially.

• High Medical, Dental, Vision Insurance
• Disability and Life insurance
• Employee Assistance Program
• Remote work options
• Generous Paid-Time Off
• Annual Reviews and Development Plans
• Retirement Plan with company match immediately 100% vested

• High School degree, some college preferred or equivalent experience.
• 1-2 years’ experience with member engagement with PBM and Medical background.
• 1-2 years’ Specialty Pharmacy or PBM experience.
• 1-2 years’ CRM platform experience.
• 1-2 years’ experience collaborating with Clinical, Prior Authorization, sales, account management, senior executive, and various external client facing relationships.

RxCompass, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, RxCompass, LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

RxCompass, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of RxCompass, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V