Pharmacy Prior Authorization Coordinator I - Remote in Virginia and Florida

City/State Norfolk, VA Work Shift First (Days) Overview: 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 Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development

•Pet Insurance •Legal Resources Plan •Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. 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. Apply To This Job