Who we are:

Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management (UM) and clinical review solutions – touching over 35M lives. For over 36 years, MRIoA has perfected the utilization and clinical review process for payers, PBM’s, and TPA’s. We offer the largest, most extensive review network in the industry. We have over 30 internal Medical Directors, 26 Nurses and 500+ Physicians across 150+ specialties with licensure in all 50 states.

Position is fully remote.

Schedule is 8 hour per day, Monday – Friday, with a set schedule between the hours of 7:00 am - 8:00 pm MST

Position Summary:

• Using your Pharmacy Technician training, the Prior Authorization Coordinator processes prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments.
• Performs analysis, obtains information, and enters prior authorization data necessary for claims adjudication.
• Utilizes reasoning skills to identify missing information and make prior authorization processing determinations based upon clinical protocols and client guidelines (approve, pend, refer for clinical decision, etc.).
• Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality.
• Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job.
• Extent of supervision ranges from close, to moderate, to minimal oversight based upon demonstrated skill and performance levels as defined for the position.
• Determine the need for additional information or additional review and notify the client and internal departments of these needs.
• Support all Quality Management initiatives.
• Actively participate in the Complaint Process and Provider Relations assessment process.
• Maintain or exceed the established monthly production benchmarks.
• Maintain or exceed the established monthly quality benchmarks.
• Participate in the “on-call” rotation coverage for weekend/holiday/ after-hours client needs on a voluntary basis.

Qualifications/Skills:

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities.
• Moderate-to-high level of medication and disease state knowledge, within the scope of pharmacy practice .
• Personal computer literacy and high competency in use of Microsoft Word, Excel, Adobe, etc.
• Strong organizational skills with attention to details.
• Strong oral and written communication skills.
• Excellent critical thinking capabilities with a strong attention to detail.
• Exceptional customer service skills.

Experience:

• Minimum one year prior authorization experience preferred but not required
• Health plan or Pharmacy Benefit Manager experience preferred but not required
• Experience with Medicare Part ‘D’ preferred but not required

Requirements:

• High school diploma or equivalent
• Required - Active Certified Pharmacy Technician (Utah or National License). License requirements and Continuing Education costs are reimbursed by MRIoA.

Environment:

Office environment: Ability to sit at a desk, utilize computer, telephone and basic office equipment.

We Offer:

• An opportunity to work with healthcare professionals, including doctors, nurses, and pharmacists, in an administrative office setting.
• A team atmosphere with fun events, and chances to win prizes.
• Growth and training opportunities; we promote from within with a Career Pathing plan.
• Generous benefits including great healthcare, vision, dental, insurance, a huge 401k match, vacation and personal time, paid holidays, and a holiday and a profit sharing bonus.
• Company-provided soda, drinks, and fruit and occasional lunches.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

MRIoA is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.