Prior Authorization Pharmacy Technician

Candidate will be working in the MagellanRX call center and will be responsible for answering around 30-50 calls per day (majority being inbound). Calls may be from enrollees, doctor offices or pharmacies and topics can include Prescription Approvals, Intiail/Prior Authorization, Claims, ID Cards, DUR (Drug Utilization Review) rejection, etc.

 Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers.

 Essential Functions:

• 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