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Certified Pharmacy Technician
Ref No.: 18-01411
Location: Phoenix, Arizona
JOB DESCRIPTION
  • High volume call center and production unit.
  • Evaluates and authorizes approval of pharmacy coverage determination 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, members, and/or pharmacists.
  • May perform clinical research to support coverage determination request.
  • Utilizes various propriety systems to build, research, process and enter coverage determinations.
  • Performs non-medical research including eligibility verification, COB, and benefits verification.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
  • Escalates requests to Pharmacist when request requires extensive clinical review or denial.
  • Promotes communication, both internally and externally to enhance effectiveness of medication therapy management services.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
  • May communicate with Healthcare Case Managers and Health Plan Staff.
  • Process requests in compliance with various laws and CMS regulations and company policies and procedures.
  • Sedentary work involving significant periods of sitting, talking, hearing, and keying.
  • Work requires visual acuity to perform close inspection of written and computer generated documents as well as dual PC monitors.