Senior Pharm Pa/Appeals Technician

$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS Realistic Job Preview Video Remote in Vermont or Maine Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.Join us to start Caring. Connecting. Growing together. The essential functions of a Senior Pharmacy PA/Appeals Technician include supporting the prior authorization and appeals process by providing accurate, timely, and professional service to members, providers, pharmacists, and internal business partners. This role is responsible for receiving, researching, documenting, and processing prior authorization requests for formulary and non-formulary medications through multiple intake channels, including phone, fax, and electronic systems. The technician reviews request information against established criteria, verifies required member, provider, medication, diagnosis, benefit, and plan details, identifies missing information, and routes clinical questions or judgment-based decisions to the appropriate pharmacist or clinician. The position requires strong attention to detail, compliance with regulatory and contractual requirements, adherence to turnaround times (TATs) and service level agreements (SLAs), and clear documentation of all interactions and case actions. Work Schedule: 8-hour shift Monday - Friday between 8am - 8pm EST with rotating on-call weekend responsibilities on Saturdays or Sundays, overtime, & holidays (work schedule will vary based on business needs) If you reside within the states of Vermont or Maine, you will enjoy the flexibility to telecommute* as you take on some tough challenges. Primary #J-18808-Ljbffr Jobtome