*THIS IS A CALL CENTER & CANDIDATE WILL BE TAKING INBOUND CALLS IN A HIGH VOLUME CALL CENTER*
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribes聽received by telephone and/or facsimile using client clinical criteria.
***AVAILABLE TO WORK ANY SHIFT MONDAY - SUNDAY; 9:00 AM-8:30 PM. WILL HAVE 2 DAYS OFF.
***NATIONAL CERTIFICATION (PTCB) REQUIRED***
ESSENTIAL FUNCTIONS:
- Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.
- Researches, resolves and documents prior authorization outcomes in pharmacy system.
- Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists.
- Escalates requests to Pharmacist when request requires extensive clinical review or denial.
- Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
- Performs other duties as required.
- Ability to identify and trouble-shoot problematic issues.