Job Summary:
- Receives and responds to calls from both provider/physicians offices and pharmacies
- Enters pharmacy overrides into the WHI system based on approved guidelines and approvals from Clinical Pharmacists
- Makes out bound calls to physicians and pharmacies
Key Duties and Responsibilities:
- Receives and responds to calls from physicians and pharmacists on a timely basis
- Enters DER overrides into the WHI system on a timely basis
- Responds to requests from member service and other issues
- Reviews member profiles for the 4 brand limit and sends letters to physicians with recommendations for changing therapies, and prepares denial letters for approval by Pharmacists
- Follows DER guidelines to make decisions on approvals and/or denials on various drug products that are not in our formulary plans
- Performs special projects as assigned
Education:
- A High School or GED required
Work Experience:
- 1+ year of experience in pharmacy operations managed care, hospitals and/or retail environments required
- 2+ years of experience in managing care pharmacy and/or appeals/grievances required
Licenses and Certifications:
- Certified Pharmacy Technician (CPhT) preferred
Skills:
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Ability to use pharmaceutical references
- Ability to evaluate information from both oral and written sources, pharmaceutical references and report information to pharmacists
- Working knowledge of prescription medications and pharmacotherapy
Technology:
- Microsoft Word Knowledge of Microsoft Office including Word, Excel and Power Point
- Microsoft Excel Capable of learning to use Sidewinder, Crystal and WHI Data bases
- Microsoft Outlook
- Healthcare Management Systems (Generic)