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Pharmacy Technician Associate (RC-24272-1)
Rancho Cordova, California | Contract
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, physicians office staff, medical management and other Blue Shield 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
- State or National Pharmacy Technician license required