Education Level: High School Graduate/GED
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.
- 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.
Minimum Requirements:
- Job Specific: Minimum of 6 months in retail, hospital or facility pharmacy setting
- An equivalent combination of experience and education is acceptable.
Other Knowledge, Skills, and Abilities:
- Licenses, Certifications, etc.: PTCB Certification or the ability to obtain PTCB Certification within one year of hire.
- Employees in states which require a Pharmacy Technician certification exam may substitute state certification for the PTCB.
- In the State of Florida, license registration with the Board of Pharmacy is required without exception.
Preferred Qualifications Education:
- High School degree or equivalent experience.
- Experience: Minimum of 6 months in retail, hospital or facility pharmacy setting required
- Knowledge, Skills, Abilities: Proficiency in Pharmacy computerized systems and software applications required
- Excellent written and verbal communication skills required.
- Ability to follow clinical criteria and instructions to approve prior authorization requests.
- Ability to use standard corporate software packages and corporate applications.
- Ability to identify and trouble-shoot problematic issues.
****SCHEDULE FOR THE FIRST 4 WEEKS OF TRAINING WILL BE: 9AM-530PM.
***SCHEDULES AFTER TRAINING:
2 ppl – Sunday-Thursday; 11:30am - 8pm (30 min lunch)
1 person- Monday- Friday 9am-5:30pm
2 ppl - Tuesday - Saturday; 11:30am - 8pm (30 min lunch)***
**STATE CERTIFICATION (VA) OR NATIONAL CERTIFICATION (PTCB) REQUIRED***
Kind Regards,
Sweta Verma
732 549-5907
Integrated Resources, Inc.
