In the insurance plan, this position is responsible for coordinating internal activities on required Rx changes i.e., prescription rider set-ups, prior authorizations and letters to members and providers. Works as liaison with leadership on assigned formulary issues, procedural management issues (formulary) and clerical management.

In outpatient pharmacy settings, this position is responsible for coordinating patient facing and internal pharmacy workflows to facilitate prior authorizations and financial assistance for pharmacy medications. Works as liaison with providers, patients, office staff and pharmacy staff to improve patient experience around medications.

This position shall coordinate, implement, and monitor assigned activities relating to the formulary medications. This position is responsible for processing, communicating, documenting, and tracking of request for medications or formulary exceptions, copay exceptions, prior authorizations, patient financial assistance and appeals processes related to drug formulary and drug utilization management with leadership and peers. This position communicates with the Pharmacy Supervisor/Manager of Pharmacy Services, members, providers, and internal staff on a regular basis. This position will also receive inbound calls from members and physicians providing excellent customer services in regard to troubleshooting any pharmacy related issues.

Overtime, flexible hours, and weekend shifts may be required intermittently to support work volumes

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. State of Nevada Pharmacy Technician license or National Pharmacy Technician certification, or equivalent with pharmacy/managed care background.

Experience:

Two years’ experience in a managed care organization and/or /2 years as a Pharmacy Technician in a retail/hospital setting.

License(s):

Current and unrestricted Pharmacy Technician License in the State of Nevada.

Certification(s):

Pharmacy Technician required (State or National).

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment. 1 year of experience with MS Outlook, Excel, & Word including basic function; email/calendar, moving through and understanding excel documents, knowing tabs, saving/editing documents