We enjoy the important work we do every day on behalf of our members.
Under the direction of the Supervisor, Pharmacy Utilization Management, the Pharmacy Utilization Management (UM) Coordinator Senior is responsible for setting up cases in the various applications for drug prior authorization (PA) requests and performs daily quality checks to ensure compliance. The technician will run test claims once authorization are approved and reach out to members and providers as necessary.
**Note: Job is currently 100% remote/home office based, but candidates will be required to commute to the Canton office location later this year.
Ability to prioritize work when processing pharmacy PA requests per guidelines and within specific turnaround timeframes.
Ability to process high volumes of requests with great accuracy.
Attention to detail and the ability to handle multiple demands and balance multiple priorities in a fast-paced environment.
Good working knowledge of medical terminology.
Must be able to work independently, and as part of a team.Regular interface with various levels of staff and management is required as well.
Must be able to exercise appropriate judgment as necessary.
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,
Fast paced office environment handling multiple demands.Open cubicle work setting with a personal computer.
Travel required on an as needed basis. Some early mornings, evenings, weekends, or extended work day may be required or as program dictates. Must have flexibility with work schedule.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!