Clinical Call Center Representative
Pharmpix Guaynabo, PR
- Expired: February 01, 2020. Applications are no longer accepted.
ESSENTIAL ROLES AND RESPONSIBILITIES1. Constantly monitors the BACMAN Alert Application to ensure proper management of rejections at point of sale.2. Change Alert status to approved or conditional denied when evaluations are completed.3.
Evaluate on an individual basis coverage determination to determine if the patient meets the criteria outlined in the guidelines or evaluation form and/or clients' stipulations.4. Forward, via email or as stipulated, to the clinical pharmacist the complete documentation if a prior authorization (including pharmacy edits) is conditional denied.5. Prepare in a timely and accurate manner notification letters to members and prescribers, as stipulated by clients and/or PharmPix policy and procedures.6.
Notify members by phone any decision about coverage determinations.7. Make outbound calls to pharmacies, providers and beneficiaries if necessary about coverage determination's decisions as stipulated by clients and/or PharmPix policies and procedures.8... Special projects and/or other duties assigned by the Clinical Manager and/or Clinical Supervisor.TRAINING & EDUCATION Pharmacy Associate or Technical DegreeCERTIFICATION & LICENSURE Puerto Rico Board of Pharmacy Technician Registry Certificate.
(Required)PROFESSIONAL EXPERIENCE 1 - 2-year clinical (pharmacy determination) unit experience (preferred but not essential