Position Purpose In the insurance plan, this position is responsible for coordinating internal activities on required Rx changes i.e., prescription rider set-ups, prior authorizations and letters to members and providers. Works as liaison with leadership on assigned formulary issues, procedural management issues (formulary) and clerical management. In outpatient pharmacy settings, this position is responsible for coordinating patient facing and internal pharmacy workflows to facilitate prior authorizations and financial assistance for pharmacy medications.
Works as liaison with providers, patients, office staff and pharmacy staff to improve patient experience around medications. Nature and Scope This position shall coordinate, implement, and monitor assigned activities relating to the formulary medications. This position is responsible for processing, communicating, documenting, and tracking of request for medications or formulary exceptions, copay exceptions, prior authorizations, patient financial assistance and appeals processes related to drug formulary and drug utilization management with leadership and peers.
This position communicates with the Pharmacy Supervisor/Manager of Pharmacy Services, members, providers, and internal staff on a regular basis. This position will also receive inbound calls from members and physicians providing excellent customer services in regard to troubleshooting any pharmacy related issues. Overtime, flexible hours, and weekend shifts may be required intermittently to support work volumes This position does not provide patient care.
Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Requirements - Required and/or Preferred Name Description
Must have working-level knowledge of the English language, including reading, writing, and speaking English.
3-5 years' experience in a managed care organization or equivalent with pharmacy/managed care background. License(s): Current and unrestricted Pharmacy Technician License in the state of Nevada strongly preferred. Certification(s): None.
Computer / Typing: Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment. 1+ year of experience with MS Outlook, Excel, & Word including basic function; email/calendar, moving through and understanding excel documents, knowing tabs, saving/editing documents
Day shift · 40