Primary Responsibilities :
- Decisioning and processing member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and / or providers for clinical information
- Consult physicians / providers with questions, interpret clinical guideline criteria, and render / review coverage determination for prior authorization cases
- Consult with pharmacy technicians and / or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
Minimum Education Requirement :
Bachelors or Doctorate of Pharmacy
Active Iowa State Pharmacist License
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Decisioning and processing member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary. Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage d...
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