This position requires the Pharmacy Technician to review, deny or approve and communicate decisions for prior authorization pharmacy requests according to clinical guidelines.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
Determines the appropriateness for medications based on clinical guidelines.
Communicates decisions 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 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.
Additional Job Details:
Six months experience in retail, hospital, or facility pharmacy setting required.
Proficiency in computerized pharmacy systems and software applications required.
Excellent verbal and written communication skills.
Ability to follow clinical criteria and instructions.