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Clinical Pharmacy Technician
Ref No.: 18-22569
Location: Middletown, Rhode Island
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.
- Monitors telephone system to ensure adequate staffing to maintain client services levels.
- Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.
- Demonstrates, advocates and reinforces a positive team environment.
- Other duties as assigned.
• Requirements/Certifications:
- HS Degree/GED
- 1 - 2 years Minimum dispensing or retail experience required.
- CPT: required to be state certified in RI
- PTCB: preferred
- 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, Client 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.
Schedule: Monday-Friday 8:30am-5:00pm