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University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Allied Health · Day Shift · POSITION SUMMARY/RESPONSIBILITIES: · Prepares pharmacy prior authorization requests for review by nurse/pharmacist/physician reviewers. Completes pharmacy authorization requests and issues review outcome notifications ...
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Applied Behavioral Therapist
3 weeks ago
University Health San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Assists Community First Health Plan (CFHP) members in regaining optimum health or improved functional capacity by ensuring that members have access to health care services they need in the most efficient and effective manner possible as it rel ...
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Applied Behavioral Therapist
2 weeks ago
University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Professional Non-Nursing · Day Shift · POSITION SUMMARY/RESPONSIBILITIES · Assists Community First Health Plan (CFHP) members in regaining optimum health or improved functional capacity by ensuring that members have access to health care services ...
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Pharmacist Pop Hlth Mgmt CFHP
2 weeks ago
University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Professional Non-Nursing · Day Shift · POSITION SUMMARY/RESPONSIBILITIES · Responsible for the administration of pharmaceutical services to CFHP members for all lines of business. Implements decisions set forth by the CFHP Pharmacy & Therapeutics ...
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Applied Behavioral Therapist
1 week ago
University Health System- San Antonio San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members in regaining optimum health or improved functional capacity by ensuring that members have access to health care services they need in the most efficient and effective manner possible as it relate ...
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Clinical Staff Education Manager
3 weeks ago
University Health System- San Antonio San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES Serves as a Manager to the Community First Health Plan (CFHP) Clinical Services support staff. Also serves as the clinical expert, educator, researcher and mentor to the Clinical Services team. Reviews healthcare service delivery and provides sta ...
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Nurse Case Manager
4 weeks ago
University Health San Antonio, TX, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Res ...
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Clinical Staff Education Manager
3 weeks ago
University Health System San Antonio, United StatesServes as a Manager to the Community First Health Plan (CFHP) Clinical Services support staff. Also serves as the clinical expert, educator, researcher and mentor to the Clinical Services team. Reviews healthcare service delivery and provides standar Clinical, Education, Manager, ...
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Clinical Staff Education Manager
3 weeks ago
University Health San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Serves as a Manager to the Community First Health Plan (CFHP) Clinical Services support staff. Also serves as the clinical expert, educator, researcher and mentor to the Clinical Services team. Reviews healthcare service delivery and provides ...
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Senior Resolution Representative
3 weeks ago
University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Clerical · Day Shift · POSITION SUMMARY RESPONSIBILITIES · Responsible for assuring complaints, website inquiries, nurse advice administrative call reports and correspondence are responded to timely. Any databases utilized in this unit should be ...
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Parts Coordinator
3 weeks ago
University Health San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES Coordinates reporting activities and supports, contract development, data analysis, and reporting. Assures all communication and tracking/monitoring of daily activity results in accurate reporting for the Resource Center. . Maintains a close work ...
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Pharmacist \ Prior Authorization Pharmacist
2 weeks ago
University Health San Antonio, TX, United StatesResponsible for the administration of pharmaceutical services to CFHP members for all lines of business. Implements decisions set forth by the CFHP Pharmacy & Therapeutics Committee. Evaluates medication utilization and prior authorization requests for medications available via t ...
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Claims Auditor
3 weeks ago
University Health System- San Antonio San Antonio, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representa ...
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Service Cooridnator
2 weeks ago
University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Clerical · Day Shift · POSITION SUMMARY/RESPONSIBIILITIES · The Service Coordinator-Non-Clinical (SC-NC) supports medical, behavioral, and social support staff within the Service Coordination team to provide a holistic evaluation of STAR Kids Mem ...
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Pharmacist Pop Hlth Mgmt CFHP
2 weeks ago
University Health San Antonio, TX, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Responsible for the administration of pharmaceutical services to CFHP members for all lines of business. Implements decisions set forth by the CFHP Pharmacy & Therapeutics Committee. Evaluates medication utilization and prior authorization re ...
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Claims Auditor
6 days ago
University Health System San Antonio, United StatesFull Time · 12238 Silicon Drive · Clerical · Day Shift · POSITION SUMMARY/RESPONSIBILITIES · Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to ...
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Data Coordinator
3 weeks ago
University Health San Antonio, TX, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Coordinates reporting activities and supports, contract development, data analysis, and reporting. Assures all communication and tracking/monitoring of daily activity results in accurate reporting for the Resource Center. . Maintains a close w ...
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Senior Resolution Representative
3 weeks ago
University Health San Antonio, United StatesPOSITION SUMMARY RESPONSIBILITIES · Responsible for assuring complaints, website inquiries, nurse advice administrative call reports and correspondence are responded to timely. Any databases utilized in this unit should be maintained, updated promptly and precisely as changes oc ...
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Therapist (Occupational or Physiotherapist)
2 weeks ago
University Health San Antonio, TX, United StatesPOSITION SUMMARY/RESPONSIBILITIES · Assists Community First Health Plan (CFHP) members in regaining optimum health or improved functional capacity by ensuring that members have access to health care services they need in the most efficient and effective manner possible as it rel ...
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Service Coordinator
3 weeks ago
University Hospital San Antonio, United StatesService Coordinator (RN) · Full Time · 12238 Silicon Drive · Nursing · Day Shift · POSITION SUMMARY/RESPONSIBIILITIES · The Service Coordinator - Registered Nurse provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, an ...
Prior Authorization Specialist II, Pharmacy Services CFHP - San Antonio, United States - University Health System- San Antonio
Description
POSITION SUMMARY/RESPONSIBILITIES:
Prepares pharmacy prior authorization requests for review by nurse/pharmacist/physician reviewers. Completes pharmacy authorization requests and issues review outcome notifications to Community First Health Plans (CFHP) members and providers. Follows clinical criteria and instructions to approve prior authorization requests based on established criteria, plan policies and procedures. Performs non-medical research including eligibility verification and benefits verification. Reviews medication utilization reports and identifies trends through advanced data analytics. Produces reports to comply with regulatory and accreditation standards.
EDUCATION/EXPERIENCE
Graduation from high school/GED required. Bachelor's degree preferred. Five years of pharmacy experience required. Some coursework at the college level is preferred. Excellent customer service, phone etiquette, attention to detail, and typing skills is required. Basic knowledge of Microsoft Office and internet required. Experience in health insurance/pharmacy insurance or managed care organization preferred. Prior authorization processing experience desired. Experience in a PBM or managed care call center desired. Knowledge of InterQual screening criteria as well as DRG, ICD-10 and CPT coding is preferred.
LICENSURE/CERTIFICATION
Texas State Board of Pharmacy registration required. Certification as a Pharmacy Technician (CPhT) is required.