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.
Monitors telephone system to ensure adequate staffing to maintain client services levels.
Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.
Demonstrates, advocates and reinforces a positive team environment.
Requirements/Certifications:
Required: Registration with FL State Board of Pharmacy
Ideal: PTCB (must obtain within a year to convert to FTE)
Call centre experience a plus
Minimum two years dispensing or retail experience required, or equivalent internal training will be substituted
Education:
High School Graduate/GED
| Location | Orlando, Florida |
| Job Type | Contractor |
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