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.
General Job Information
Clinical Pharmacy Technician
United States of America
United States of America (Non-Exempt)
Recruiting Start Date
Date Requisition Created
GED (Required), High School (Required)
License and Certifications - Required
CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Other Job Requirements
* CPT: Certification/licensure in accordance with state requirements. In the states of Florida and Michigan, license registration with the Board of Pharmacy is required without exception.
* PTCB: Certification or the ability to obtain PTCB Certification within one year of hire. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the PTCB.
* 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.
* Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
* Ability to identify and trouble-shoot problematic issues.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
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