Remote Clinical Reviewer Jobs in Racine, WI (NOW HIRING)

Are you looking for a positive workplace culture, a training program that prepares you for success, and the career advancement opportunities that allow you to shine? Serve You Rx is looking for a Clinical Prior Authorization Technician to provide administrative support to the Prior Authorization team for clinical pharmacy initiatives including the prior authorization review process and other administrative and project-related functions within the Clinical Department.

Serve You Rx offers clinical services and strategies designed to manage drug costs, ensure appropriate drug use, and improve member outcomes. This position plays a key role in supporting Serve You Rx in reaching its mission to help clients and members have a cost efficient and money-saving way to get the prescriptions they need.

This position is available on a full-time or part-time basis and is open to remote work.

What You’ll Do:

As the Clinical Prior Authorization Technician I, you will:

• Enter new PA data into the PA system such as patient, provider, and drug information.
• Process PA renewal requests by matching existing patient data with system data for clinical review.
• Monitor PA cases for response, send follow-up requests for information, troubleshoot failed faxes, contact prescriber offices via outbound call and other means, while adhering to HIPAA guidelines and other policies and procedures.
• Sort and assign PA requests (faxes, emails, etc.) for clinical case analysis, direct to assigned clinical staff.
• Accurately work assigned queues and fulfil other responsibilities within the PA management solution.
• Review rejection reports to proactively managing clinical interventions.
• Enter patient information into the requisite database as a part of new enrollments under the alternative funding program.
• Use the Internet, telephone, and other means to research alternative funding sources for medications not covered by the plan.
• Assist with maintaining reference materials about alternative funding availability and eligibility requirements.
• Communicate effectively with patients, prescriber’s offices, and third-party payers about plan design, coverage requirements, and clinical programs.
• Adhere to federal, state, and company rules and regulations related to security of paper and electronic patient health information (PHI)
• Process mail merges and prepare outgoing mail.
• Place overrides into the requisite database as approved by the clinical team or client.
• Perform other duties as assigned.

Qualifications:

• High school diploma or GED.
• Minimum of one year of previous administrative experience in a related field to include employee benefits and/or pharmacy/prescription drugs, or similar experience.
• Minimum of one year of medical terminology or prior authorization experience for prescription benefit preferred.
• National Pharmacy Technician Certification (PTCB) is preferred.

Why Serve You Rx?

Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.

The company offers generous benefits for full-time employees to include: medical (HMO and PPO), dental, vision, 401k, HSA, identity theft and legal coverage, pet insurance, paid parental leave, and 18 days of paid time off in your first year.

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