Job Description:
• 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, physician’s office staff, medical management staff, and/or pharmacists.
• Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician’s 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.