Duration: 1 year contract with a possibility of extension
Training hours will be from 8:00 am to 4:30 pm. We need to fill later shifts, so count on working a shift that ends between 6:00 pm - 7:15 pm.
Must have call center experience and pharmacy experience.
State Registration Certification or National Certification.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physicians office staff, medical management staff, and/or pharmacists. Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physicians office staff, medical management staff, and/or pharmacists. Researches, resolves, and documents prior authorization outcomes in the pharmacy system. Escalates requests to Pharmacist when request requires extensive clinical review or denial. Researches, resolves, and documents physician or client inquiries and grievances. Provides verbal or written results to client, prescriber, provider, and/or management. Performs other duties as required.