City/State
Norfolk, VA
Work Shift
First (Days)
Status: Full-time, permanent position (40 hours)
Work hours: 8am to 5pm EST, M-F
Location: This is a remote position in Virginia and Florida. The position requires being on the phone and computer for the majority of the 8-hour shift
The Pharmacy Prior Authorization Coordinator delivers high-quality customer service by managing calls from members, providers, and pharmacies while processing pharmacy benefit prior authorization (PA) requests with accuracy and compliance.
Working under general supervision, theCoordinatoruses established protocols, business systems, and clinical guidelines to analyze requests, enter data forclaimsadjudication, and determineappropriate actionssuch as approval, pending, or referral.
This role requires strong reasoning and communication skills to ensuretimely, efficient, and consistent service delivery in collaboration with internal teams and external partners.
Key Responsibilities
Review and process pharmacypriorauthorization requests using established guidelines.
Verify member eligibility and pharmacy benefit coverage.
Communicate PA status updates to members, providers, and pharmacies.
Identifyand resolve missing or incomplete information.
Ensure requests are completed within required turnaround times (TAT) and performance guarantees.
Document PA decisions clearly and accurately.
Collaborate with internal pharmacy teams to resolve inquiries.
Maintain confidentiality and data security at all times.
This position requires strong attention to detail, critical thinking, and excellent communication skills to deliver consistent, high-quality service in a fast-paced environment.
Education
High School Diploma or GEDstronglypreferred.
Certification/Licensure
Certified Pharmacy Technician (CPhT ) preferred
Experience
1yearhealthcare experience REQUIRED
Pharmacy OR Prior Authorization or Call Center experience highly preferred
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-100001
Talroo – Health Plan
Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Pharmacy, Prior Authorization, Coordinator, Remote, Virginia, Florida, Call Center, HS Diploma, GED
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work,Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018).
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