El Rio
Medication Prior Authorization Specialist - Manning - Quality
El Rio, Tucson, Arizona, United States, 85718
Medication Prior Authorization Specialist - Manning - Quality
Manning House I, 450 W. Paseo Redondo, Tucson, Arizona, United States of America
Job Description Posted Friday, September 5, 2025 at 9:00 AM
Salary: $19.33 - $26.57, depending on experience
Schedule: Monday to Friday 8am - 5pm
JOB PURPOSE:
The Medication Prior Authorization Specialist is responsible for facilitating and processing medication prior authorizations to ensure timely patient access to prescribed therapies. This role operates within the Quality Department and ensures that all processes related to medication prior authorizations adhere to regulatory standards, quality control protocols, and best practices. The main function is to complete prescription prior authorizations and to ensure patients receive medications that require pre-authorization from insurance carriers. The Specialist communicates with plans and pharmacies by analyzing insurance prior authorization requirements. The Specialist receives, processes and documents all requirements, submits the required documentation, and updates Prior Authorization submission documents when necessary. They collaborate with cross-functional teams to monitor, assess, and improve the quality of processes for prescription prior authorizations and medication services. This role requires a deep understanding of quality assurance principles and strong analytical skills. The Specialist may be asked to perform other tasks in support of the Quality and Innovation team and serves in a specialized administrative support role.
In this position, duties and responsibilities will adhere to the regulations and the Policies and Procedures of El Rio Health. The Quality team works with periodic supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are reviewed with the supervisor for direction and resolution.
Essential Job Functions
Performs and/or completes all assigned duties, tasks, responsibilities, and assignments supporting the quality team with focus on Medication Prior Authorizations within established time frames; meeting established rates of performance for the quality and quantity of work; demonstrating a high level of technical expertise, quality, efficiency, and accuracy to ensure the highest standards of excellence.
Maintains proficient skill levels that meet defined performance expectations for a Medication Prior Authorization Specialist as evidenced by successful demonstration of skills performance upon evaluation.
Maintains patient and employee confidentiality by controlling the environment and information disclosed to authorized individuals, ensuring compliance with HIPAA and corporate compliance standards.
Understands and complies with organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all patients, visitors, employees, and clients or representatives.
Delivers professional attitude and job performance for all duties and assignments to support the operational needs of El Rio Health as assigned by leadership.
Possesses knowledge and skills to complete all duties and responsibilities, including working with the electronic health record.
Acts as an informational contact point for El Rio’s Quality & Innovation Team in relation to Medication Prior Authorizations, supporting payors toward timely resolution.
Collects, analyzes, and interprets quality-related data to identify trends and opportunities for enhancement.
Initiates authorization requests for Pharmacy in line with the prior authorization workflow.
Processes faxes within established standards and follows up with plans and pharmacies.
Gains and maintains a comprehensive understanding of and ability to ensure full compliance with all regulations, standards, or requirements for Federal, State, and local laws and internal/external grants or funding sources.
Minimum Education and Experience:
High School Diploma or General Education Diploma (G.E.D).
Three (3) years of experience working with insurance plans, Pharmacy benefits (PBM), and eligibility.
Two (2) years experience processing Medication Prior Authorizations, insurance verification and formularies.
Familiarity with EHRs EPIC
Required Licenses, Certifications, and Registrations:
Current certification in Basic Life Support (BLS) for health care providers.
Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If driving during work hours, a valid driver’s license and compliance with Arizona vehicle insurance requirements are required.
Preferred Education, Experience, Skills, Abilities:
Associate’s Degree in a Business or Finance related field from an accredited College or University.
A current License as a Pharmacy Technician in accordance with the Arizona State Board of Pharmacy requirements.
Two (2) years administrative experience, preferably in a healthcare environment.
Bilingual (English/Spanish) with the ability to speak, read and write in both languages.
Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job.
El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.
El Rio Health requires all employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after applying for the fingerprint card.
All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination.
Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045).
All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.
El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.
Job Family Specialist
Pay Type Hourly
Education Level High School
Manning House I, 450 W. Paseo Redondo, Tucson, Arizona, United States of America
#J-18808-Ljbffr
Job Description Posted Friday, September 5, 2025 at 9:00 AM
Salary: $19.33 - $26.57, depending on experience
Schedule: Monday to Friday 8am - 5pm
JOB PURPOSE:
The Medication Prior Authorization Specialist is responsible for facilitating and processing medication prior authorizations to ensure timely patient access to prescribed therapies. This role operates within the Quality Department and ensures that all processes related to medication prior authorizations adhere to regulatory standards, quality control protocols, and best practices. The main function is to complete prescription prior authorizations and to ensure patients receive medications that require pre-authorization from insurance carriers. The Specialist communicates with plans and pharmacies by analyzing insurance prior authorization requirements. The Specialist receives, processes and documents all requirements, submits the required documentation, and updates Prior Authorization submission documents when necessary. They collaborate with cross-functional teams to monitor, assess, and improve the quality of processes for prescription prior authorizations and medication services. This role requires a deep understanding of quality assurance principles and strong analytical skills. The Specialist may be asked to perform other tasks in support of the Quality and Innovation team and serves in a specialized administrative support role.
In this position, duties and responsibilities will adhere to the regulations and the Policies and Procedures of El Rio Health. The Quality team works with periodic supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are reviewed with the supervisor for direction and resolution.
Essential Job Functions
Performs and/or completes all assigned duties, tasks, responsibilities, and assignments supporting the quality team with focus on Medication Prior Authorizations within established time frames; meeting established rates of performance for the quality and quantity of work; demonstrating a high level of technical expertise, quality, efficiency, and accuracy to ensure the highest standards of excellence.
Maintains proficient skill levels that meet defined performance expectations for a Medication Prior Authorization Specialist as evidenced by successful demonstration of skills performance upon evaluation.
Maintains patient and employee confidentiality by controlling the environment and information disclosed to authorized individuals, ensuring compliance with HIPAA and corporate compliance standards.
Understands and complies with organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all patients, visitors, employees, and clients or representatives.
Delivers professional attitude and job performance for all duties and assignments to support the operational needs of El Rio Health as assigned by leadership.
Possesses knowledge and skills to complete all duties and responsibilities, including working with the electronic health record.
Acts as an informational contact point for El Rio’s Quality & Innovation Team in relation to Medication Prior Authorizations, supporting payors toward timely resolution.
Collects, analyzes, and interprets quality-related data to identify trends and opportunities for enhancement.
Initiates authorization requests for Pharmacy in line with the prior authorization workflow.
Processes faxes within established standards and follows up with plans and pharmacies.
Gains and maintains a comprehensive understanding of and ability to ensure full compliance with all regulations, standards, or requirements for Federal, State, and local laws and internal/external grants or funding sources.
Minimum Education and Experience:
High School Diploma or General Education Diploma (G.E.D).
Three (3) years of experience working with insurance plans, Pharmacy benefits (PBM), and eligibility.
Two (2) years experience processing Medication Prior Authorizations, insurance verification and formularies.
Familiarity with EHRs EPIC
Required Licenses, Certifications, and Registrations:
Current certification in Basic Life Support (BLS) for health care providers.
Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.
Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If driving during work hours, a valid driver’s license and compliance with Arizona vehicle insurance requirements are required.
Preferred Education, Experience, Skills, Abilities:
Associate’s Degree in a Business or Finance related field from an accredited College or University.
A current License as a Pharmacy Technician in accordance with the Arizona State Board of Pharmacy requirements.
Two (2) years administrative experience, preferably in a healthcare environment.
Bilingual (English/Spanish) with the ability to speak, read and write in both languages.
Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job.
El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.
El Rio Health requires all employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after applying for the fingerprint card.
All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination.
Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045).
All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.
El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer.
Job Family Specialist
Pay Type Hourly
Education Level High School
Manning House I, 450 W. Paseo Redondo, Tucson, Arizona, United States of America
#J-18808-Ljbffr