Pharmacy Prior Authorization Coordinator I - Remote in Virginia and Florida

Sentara Healthcare is currently hiring a Pharmacy Prior Authorization Coordinator I - Remote in Virginia and Florida! 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

Overview

• 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, the Coordinator uses established protocols, business systems, and clinical guidelines to analyze requests, enter data for claims adjudication, and determine appropriate actions such as approval, pending, or referral.
• This role requires strong reasoning and communication skills to ensure timely, efficient, and consistent service delivery in collaboration with internal teams and external partners.

Key Responsibilities

• Review and process pharmacy prior authorization requests using established guidelines.
• Verify member eligibility and pharmacy benefit coverage.
• Communicate PA status updates to members, providers, and pharmacies.
• Identify and 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 GED strongly preferred.

Certification/Licensure

• Certified Pharmacy Technician (CPhT) preferred

Experience

• 1 year healthcare 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 Apply To This Job