Certified Pharmacy Tech 1 - Remote

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria in a call center environment.

Job Description

• Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.
• Research, 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.
• Research, 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.
• For CPTs assigned to work the fax queue, responsibilities will also include:
• Clinically reviews coverage determinations with attention to detail, for medications via Fax. Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists within SLA (service level agreement) guidelines.
• Efficiently multi-tasks and monitors several queues and assignments. Adapts to team requirements as business needs change (e.g., fax work, pending queues, oral notifications, and failed faxes).