Pharmacy Specialist Level 1
Integrated Resources Inc
Job SummaryResponsible for processing prior authorization requests and supporting pharmacy services, including claims analysis, reporting, and coordination of clinical programs. Ensures compliance with organizational goals and regulatory requirements.Key ResponsibilitiesReview and process prior authorization requests based on medical necessity and criteriaCommunicate with physicians, pharmacies, members, and internal teams regarding eligibility, coverage, and claimsFacilitate formulary compliance and promote generic utilizationHandle appeals, complaints, and compliance-related inquiriesSupport reporting, data requests, and special projectsAssist with training for clients, members, and staffSupport daily pharmacy operations and Medication Therapy Management (MTM) programsRecommend improvements to enhance efficiency and productivityEducation & ExperienceBachelor s degree (preferred) in Healthcare Management, Business, or Pharmaceutical AdministrationMinimum 2 years of experience in:Prescription claims adjudicationPharmacy Utilization ManagementPrior customer service experience required
Vacancy posted 2 days ago
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