About the Company
Manulife is a leading international financial services group that helps people make their decisions easier and live better. We provide financial advice, insurance, and wealth and asset management solutions for individuals, groups, and institutions. Operating as John Hancock in the United States and Manulife elsewhere, we have operations in Asia, Canada, and the United States, and are committed to fostering a diverse and inclusive work environment where every employee can thrive and contribute to our mission.
Job Description
We are seeking a dedicated and detail-oriented Remote Pharmacy Prior Authorization Specialist with a strong focus on Payor Services to join our growing team. In this 100% remote role, you will be responsible for processing and managing pharmacy prior authorization requests, ensuring timely approvals, and collaborating with healthcare providers and insurance payors. You will play a crucial role in facilitating access to essential medications for our clients by accurately interpreting clinical information and navigating complex payor guidelines. This position requires strong organizational skills, excellent communication, and a comprehensive understanding of pharmacy benefit management processes.
Key Responsibilities
- Process pharmacy prior authorization requests in accordance with established policies and payor guidelines.
- Communicate effectively with prescribing physicians, pharmacies, and insurance companies to obtain necessary clinical documentation and authorization updates.
- Review patient medical records and clinical criteria to determine medical necessity for requested medications.
- Accurately document all interactions, decisions, and outcomes in the authorization system.
- Adhere to all regulatory compliance standards, including HIPAA and other privacy regulations.
- Manage a caseload of prior authorization requests, ensuring all deadlines are met.
- Provide exceptional customer service and support to all stakeholders regarding prior authorization status and requirements.
- Identify and escalate complex cases or issues to appropriate clinical staff or management.
- Maintain up-to-date knowledge of current pharmacy benefit designs, formularies, and prior authorization requirements across various payors.
Required Skills
- Minimum of 3 years of experience in pharmacy operations, prior authorization, or a related healthcare administrative role.
- Strong understanding of pharmacy benefit management (PBM) processes and medical/pharmacy terminology.
- Proficiency in navigating various payor portals and electronic health record (EHR) systems.
- Excellent written and verbal communication skills, with the ability to articulate complex information clearly.
- Exceptional attention to detail and organizational abilities.
- Proven ability to work independently and manage time effectively in a fast-paced remote environment.
- Proficiency with Microsoft Office Suite (Word, Excel, Outlook).
- High school diploma or equivalent.
Preferred Qualifications
- Certified Pharmacy Technician (CPhT) certification.
- Associate's or Bachelor's degree in a healthcare-related field.
- Previous experience working remotely.
- Familiarity with Canadian healthcare and insurance systems.
- Experience with specialty medications and complex disease states.
Perks & Benefits
- Competitive salary and performance-based incentives.
- Comprehensive health, dental, and vision insurance coverage.
- Generous paid time off and holiday schedule.
- Opportunities for professional development and continuing education.
- Retirement savings plans with company match.
- Employee wellness programs and resources.
- Access to a collaborative and supportive remote work culture.
How to Apply
If you are interested in this position, please click the "Apply Now" button below. To ensure your application is properly considered, please prepare the following:
- An up-to-date Resume or CV
- A brief cover letter summarizing your experience and motivation
Applications are reviewed on a rolling basis. Only shortlisted candidates will be contacted for an interview.
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