Texas Licensed Prior Authorization Manager

Job Summary

A company is looking for a Manager, Prior Authorization Oversight.

Key Responsibilities

• Develop and maintain prior authorization policies and procedures compliant with regulations
• Provide oversight on utilization management turnaround times and ensure compliance
• Represent the PA team during audits from regulatory bodies and support compliance initiatives

Required Qualifications

• Active, unrestricted pharmacist license required
• 1+ years of prior authorization review or appeals experience required
• 2+ years of compliance or regulatory experience at a PBM or health plan required
• Extensive knowledge of Medicare, ERISA, and state-regulated prior authorization requirements required
• Intermediate to advanced Microsoft Excel skills required