Clinical Pharmacy Technician I

Clinical Pharmacy Technician I

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.

Qualifications

Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.

CPT - Certification/licensure in accordance with state requirements.

PTCB National certification required.

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.

Ability to identify and trouble-shoot problematic issues.

Schedules for the first 4 weeks of training will be: 9AM-5:30PM.

Schedules after training - all possible shifts:

5 people - Monday - Friday; 9am-5:30pm (30 min lunch)

3 people - Tuesday-Saturday 12pm-8:30pm (30 min Lunch)