TT
Pharmacy Services 2
Talent Technical Services, Inc
- 🇺🇸 United States
- Remote
- 1 day ago
- $20 – $23 / hour
- prior authorization
- Excel
- Outlook
1 day ago
The main function of Pharmacy Services is to provide efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members and brokers) and internal team members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review and consumer affairs issues.
Job Responsibilities:
• Under general supervision, coordinates, assists in and supports implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit.
•Communicates with the physician, physician’s office staff, medical management and other Cross team members to assist with accurate and efficient resolution of prior authorization requests
•Assists in providing formulary alternatives and communicates prior authorization criteria, and discusses pharmacy benefit coverage inclusions/exclusions when required
•Interfaces in a courteous and professional manner with physicians, physician office staff, contracted pharmacists, patients, and other Cross team members during the prior authorization process
•Provides drug usage history and other pertinent pharmacy benefit related computer searches for pharmacists and Medical Director to assist in case specific reviews and drug evaluations.
•Assists pharmacists with drug utilization review programs, NCQA QI programs or other assigned projects
•Communicates prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physician, physician office staff, medical management staff, sales, member/customer services
•Assists in research and resolution of physician inquiries and grievances
•Provides essential clinical information to BSC Member Services, Administrative Review Department and Consumer Affairs to resolve Member inquires and grievances
Education and Experience:
•Currently in training or recently completed training but has not consistently reached production/quality standards
• 2-4 years’ experience required.
Custom Fields:
Name: Required Certifications
Value: Pharmacy Technician certification (CA State licensure or PTCB)
Name: Disqualifiers/Dislikes on Resumes
Value: no prior pharmacy tech experience
Name: Who will conduct interviews
Value: supervisor - Joshua Eremia
supervisor - Mai Ker Vang
supervisor - Krista Barlow
Name: Interview Process
Value: typical interview introductions, questions regarding prior employment and experience, situational pharmacy tech questions
Name: calPERS
Value: No
Name: Will this person be using VDI on their personal laptop instead of having a physical laptop issued from Cross?
Value: None
Name: BSC Network Access
Value: Network Access
Name: Would you be open to hiring workers outside of California in lower cost markets?
Value: No
Name: Will this worker be supporting HMO or PPO?
Value: None of the above
Name: Interview Method
Value: Video Interview
Name: Preferred/nice to have skills
Value: n/a
Name: Is there a potential to extend past the original assignment duration?
Value: No
Name: CostCenterOU
Value: Pharmacy Strategy and Operations
Name: Top 3 Required Skills
Value: attention to detail, problem solving, communication skills
Name: Resource Type
Value: Staffing
Name: Work Set up
Value: Remote
Name: Will this worker be working on VDI?
Value: no
Name: Required Testing?
Value: Does Not Apply
Name: Travel Required? If so, please elaborate
Value: no
Name: Software Skills Required
Value: Microsoft Office programs (Word, Excel, Outlook)
Name: Potential to Convert to FTE?
Value: unsure at this time
Name: Number of Interviews
Value: 1
Name: Education Requirements
Value: Pharmacy Technician certification (CA State licensure or PTCB)
Name: Company of Origin
Value: ***
Name: Niche Skills
Value: None
Pharmacy Services 2 · Talent Technical Services, Inc