SGS Consulting
You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Caremark Specialty Medical Prior Authorization department.
Experience: Minimum 2 years’ recent experience reviewing and processing Prior Authorizations against health plan criteria for a determination in a specialty/skilled clinical setting,g i.e., Specialty Medical Office or Pharmacy Benefits Manager (PBM) Education: LPN with current unrestricted state licensure.
Responsibilities include Answering Inbound Phone Calls, Processing Cases and Electronic Authorizations, loading Authorizations, and making follow-up phone calls utilizing appropriate, courteous and professional behavior based upon established standards. Review criteria-based Prior Authorizations following policy and procedure.
Basic
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