Supports the implementation and administration of outpatient pharmacy benefit prior authorization procedures. Reviews medication requests, provides pharmacy benefit guidance, and communicates with healthcare providers, pharmacies, and internal partners to resolve inquiries accurately and efficiently.
Responsibilities
Coordinate, assist with, and support procedures and guidelines for the outpatient pharmacy benefit prior authorization program.
Evaluate prior authorization requests according to medication policies and operational principles.
Provide drug usage history and relevant pharmacy benefit information to support case reviews and medication evaluations.
Communicate with physicians, physician office staff, pharmacies, and internal business partners to resolve pharmacy benefit inquiries.
Explain formulary alternatives and prior authorization criteria.
Discuss pharmacy benefit coverage and requirements when needed.
Collaborate with member services and external vendors as appropriate.
Requirements
Active California Pharmacy Technician License.
Proficiency with Microsoft Word, Teams, Outlook, and Excel.
Ability to interpret medication policies and pharmacy benefit guidelines.
Strong written and verbal communication skills.
Skill
Pharmacy benefit and prior authorization knowledge.
Case review and medication policy interpretation.
Healthcare provider and pharmacy communication.
Microsoft Office proficiency.
Summary Qualification
Experience supporting pharmacy services, pharmacy benefits, or prior authorization programs.
Ability to review clinical and benefit-related information accurately.
Strong attention to detail and problem-solving skills.
Ability to communicate clearly with internal and external stakeholders.
Valid California Pharmacy Technician License.
Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.
Numbers & Facts
Location
Rancho Cordova, CA
Skills
Access Authorizationunmatched
Communication Skillsunmatched
Detail Orientedunmatched
Diversity Recruitingunmatched
Formularyunmatched
Healthcare Providersunmatched
Legalunmatched
Medical Officeunmatched
Medical Treatmentunmatched
Medicationsunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Outlookunmatched
Microsoft Wordunmatched
Patient Care Authorizationsunmatched
Pharmacyunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
Writing Skillsunmatched
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