Pharmacy Specialist Level 1

Job title: Pharmacy Specialist Level 1
Location:  Remote
Duration: 6  Months+ (Possibility of Extension)

Schedule Notes:  Monday to Friday - 8 : AM EST to 4 : 30 PM EST

Job Duties:

This position is responsible for receiving verbal and written requests for prior authorization from pharmacists, physicians and/or patients and is responsible for supporting and assisting in the coordination of Pharmacy Services activities including claim utilization analysis, prescription plan design, ad-hoc reporting, correspondence and special projects. Must maintain performance in compliance with organizational or department goals and in compliance with regulatory agencies

Skills/Requirements:

Process prior authorizations received via prior authorization help line, by evaluating the medical necessity/appropriateness for specific drugs and based on medical criteria.
Directly interact with members physician office staff, pharmacies and internal stake holders for eligibility, coverage determination claims issues.
Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
Process appeals complaints executive inquiries and compliance related issues.
Provide recommendations to increase efficiency, accuracy and productivity in the department.

Cerfication:
Active Pharmacy Tech licensure!

Education:

High School Diploma or Higher Education!