Clinical Pharmacy Technician (December) at Magellan Health in rancho cordova, California

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

• LPT:L icensure in accordance with California state requirements.


• 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
Clinical Pharmacy Technician (December)

Grade
17

Work Experience
Pharmacy

Education
GED (Required), High School (Required)

License and Certifications - Required
LPT - Licensed Pharmacy Technician - 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.