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- Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit
- Evaluate prior authorization requests based on medication policy and operational principles
- Provide drug usage history and other pertinent pharmacy benefit related inquiries to internal business partners to assist in case specific reviews and drug evaluations
- Communicate with the physician, physician's office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries
- Clearly communicate formulary alternatives and prior authorization criteria, and discusses pharmacy benefit coverage when required
Pharmacy Technician, Intermediate - Long Beach, United States - Blue Shield of California
Description
Your Role
The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will resolve outpatient pharmacy benefit coverage inquiries, including prescription claim processing problems, and communication of drug formulary guidelines and alternatives.
Your Work
In this role, you will: