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Pharmacy Services Associate-25448-1 MPK

Monterey Park, California | Contract

Job ID: 55436 Position: Biotechnology/Pharmaceuticals Branch: Torrance


Day to Day Responsibilities of this Position and Description of Project:

Pharmacy Services Operations Associate

Provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members and brokers) and internal team members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review and consumer affairs issues.

• Under general supervision, coordinates, assists in and supports implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit.

• Communicates with the physician, physician’ s office staff, medical management and other team members to assist with accurate and efficient resolution of prior authorization requests

• Assists in providing formulary alternatives and communicates prior authorization criteria, and discusses pharmacy benefit coverage inclusions/exclusions when required

• Interfaces in a courteous and professional manner with physicians, physician office staff, contracted pharmacists, patients, and other team members during the prior authorization process

• Provides drug usage history and other pertinent pharmacy benefit related computer searches for pharmacists and Medical Director to assist in case specific reviews and drug evaluations.

• Assists pharmacists with drug utilization review programs, NCQA QI programs or other assigned projects

• Communicates prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physician, physician office staff, medical management staff, sales, member/customer services

• Assists in research and resolution of physician inquiries and grievances

• Provides essential clinical information to Member Services, Administrative Review Department and Consumer Affairs to resolve Member inquires and grievances

Education and Experience:

Currently in training or recently completed training but has not consistently reached production/quality standards

Identifies issues and with assistance executes corrective action

In process of developing specific skills needed to perform non-routine tasks

Generally requires minimal (0-2 years) pharmacy related experience

At least 2 years of Pharmacy experience

Good verbal and written communication

Typing: 40 wpm min

Must be customer service oriented

Current California Pharmacy Tech License, National Pharmacy Technician license preferred

Rachel Savitt
Staffing Manager

Rachel rejoined the Wollborg Michelson Recruiting team in Torrance as the Staffing Manager. She previously worked for the company from 2006-2009 as a Recruiter for the Temporary division. Rachel brings over 16 years of Staffing Industry experience. She has worked on all sides of the industry as a temporary employee, client, full desk Recruiter as well as corporate for a Staffing Company. Her goal is to change the lives of everyone she works with no matter what their role. In her free time, Rachel enjoys spending time with her friends and family. She is active with multiple non-profit animal rescues and prefers to ask for donations instead of gifts for birthday. She also enjoys kickboxing, Muay Thai and dancing. Rachel always finds a way to connect with people. Her #1 Strength from Strengthfinders is Connectedness.

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