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Clinical Pharmacy Technician (653069)
Ref No.: 18-10957
Location: Middletown, Rhode Island
Start Date / End Date: 09/10/2018 to 12/31/2018
Job Title: Clinical Pharmacy Technician (653069)
Location: Middletown RI 02842
Duration: 3 Months

 
Job Summary:
  • Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.
 
Essential Functions:
  • 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, 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.