Prior Authorization Pharmacy Technician

Candidate will be working in the MagellanRX call center and will be responsible for answering around 30-50 calls per day (majority being inbound). Calls may be from enrollees, doctor offices or pharmacies and topics can include Prescription Approvals, Intiail/Prior Authorization, Claims, ID Cards, DUR (Drug Utilization Review) rejection, etc.

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers.

Essential Functions:

• 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

• Must have either a Pharm Tech Certification(CPT) in the state of VA or have the PTCB (national certification)
• At least 6 months of dispensing or retail experience (equivalent internal training will be substituted)
• Previous reimbursement experience and/or working in a health plan/healthcare setting
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary (preferred drug list) management techniques (ability to objectively discriminate between superior and marginal medications), medical terminology and/or current diagnostic/reimbursement clinical criteria
• Knowledge of prior auth
• Ability to identify and trouble-shoot problematic issues
• Proficiency in Pharmacy computerized systems and software applications and MS Office Product Suite

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm