Responsibilities
- Track coverage determination requests
- Obtain verbal authorizations
- Approve requests based on criteria
- Enter decisions into the PBM system
- Notify providers and members of decisions
- Respond to client inquiries
- Refer requests for specialty drugs
- Contact providers for additional information
- Notify stakeholders of decision outcomes
- Obtain detailed clinical information from prescribers
- Assist with inbound and/or outbound patient or physician calls if needed
Requirements
- High School diploma or GED
- State Registration AND National Certification
- Basic computer skills
- Experience with Prior Authorization processes
- Proficiency in Microsoft Office and Outlook
- Data entry skills
Work Environment
- This is a professional remote environment where you will work with multiple screens and systems.
- You must have a strong WiFi connection and a dedicated office space with a closed door.
- The shift is Monday to Friday, from 8 am to 8 pm (Open for 8-hour Shifts), with rotating weekends every 4-6 weeks and some holidays.
- Training is conducted from 10 am to 6:30 pm EST.
- The company provides equipment, including a computer, monitor, and headset.
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following: Medical, dental & vision
Critical Illness, Accident, and Hospital
401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
Life Insurance (Voluntary Life & AD&D for the employee and dependents)
Short and long-term disability
Health Spending Account (HSA)
Transportation benefits
Employee Assistance Program
Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jul 25, 2025. About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email ... for other accommodation options.