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Customer Care Clinical Pharmacy Technician

Company: Magellan Health
Location: San Diego
Posted on: November 22, 2020

Job Description:

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. * Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management. * Performs other duties as required. OTHER JOB REQUIREMENTS RESPONSIBILITIES * CPT: Certification/licensure in accordance with state requirements. In the states of Florida, Rhode Island and Michigan, license registration with the Board of Pharmacy is required without exception. * National Certification such as PTCB or ExCPT: Certification or the ability to obtain certification within one year of hire. Employees in states which require a Pharmacy Technician certification/registration exam may substitute state certification/registration for the national certification. * Active Pharmacist license supersedes requirement for CPT and/or PTCB. * Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting. * In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.). * Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite. * Excellent written and verbal communication skills. * Ability to follow clinical criteria and instructions to approve prior authorization requests. * Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted. * Ability to identify and trouble-shoot problematic issues. GENERAL JOB INFORMATION TITLE Customer Care Clinical Pharmacy Technician GRADE 17 WORK EXPERIENCE Pharmacy EDUCATION GED (Required), High School (Required) LICENSE AND CERTIFICATIONS - REQUIRED CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy LICENSE AND CERTIFICATIONS - PREFERRED Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

Keywords: Magellan Health, San Diego , Customer Care Clinical Pharmacy Technician, Professions , San Diego, California

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