Clinical Pharmacy Technician

*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 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.

• CPT: Certification/ licensure in accordance with state requirements.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary
• management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Excellent written and verbal communication skills.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to identify and trouble-shoot problematic issues.

All your information will be kept confidential according to EEO guidelines.