Job Description

Steward Health Choice is dedicated to improving the health and well-being of the people and communities we serve.

Steward Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.

Steward Health Choice provides exceptional customer service and culturally competent care through:

  • Compassionate and responsive member services team
  • Collaboration with community physicians to help members get the health care they need
  • Providing culturally competent health care, including extensive translation and interpretation services
  • Health programs to help members and their families stay healthy

Position Purpose:

The Pharmacy Technician processes written and telephone requested services by providers for Health Choice members within established timeframes, following Health Choice criteria and guidelines. This position also completes data entry and provider notification to ensure timely service to members and answers a high volume of calls within contract-mandated timeframes.

  • Answer prior authorization/pharmacy calls
  • Review prior authorization requests
  • Review requests based on current medication formulary and Health Choice established guidelines
  • If determination is not made, forward PA request to Supervisor/Manager
  • Contact referring provider to obtain additional information needed to make determination
  • Fax decisions to requesting providers
  • Enter appropriate authorizations and notify provider of approval
  • Document criteria met in electronic medical record system
  • Complete processing within established timeframes
  • Process incoming faxes
  • Assist other departments with Prior Authorization needs
  • Assist Utilization Review Nurses with obtaining authorizations and coordinating care for discharge planning, forward appropriate referrals to case management
  • Enter authorizations for nurses for discharge care
  • Collaborate with MCH and Behavioral Health staff for pharmacy-related requests
  • Assist Member Services with formulary questions and pharmacy requests
  • Assist Disputes/Appeals department with pharmacy-related information during appeals process
  • Provide ongoing education and training to physician offices and facilities
  • Inform offices of any updated or changed policies and procedures or changes to the formulary
  • Ensure all physicians and facilities are educated on proper authorization procedures as well as new pharmacy guidelines
  • Educate providers regarding Medicare benefits

Education / Experience / Other Requirements

Education:

  • High School Diploma / GED

Work Related Experience:

  • Certified Pharmacy Tech active and good standing in Arizona
  • Previous Medicaid / Medicare experience
  • Previous call center experience

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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