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Pharmacy Services Coordinator

2 months ago

Rancho Cordova, California, United States TALENT Software Services Full time
Job Summary:

The Pharmacy Services team at Talent Software Services is responsible for providing efficient and accurate responses to external customers and internal team members. The ideal candidate will be responsible for resolving outpatient pharmacy benefit coverage issues, communicating drug formulary guidelines, and researching administrative review and consumer affairs issues.

Key Responsibilities:
  • Under general supervision, coordinate and assist in the implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit.
  • Communicate with physicians, medical management, and other cross-functional team members to assist with accurate and efficient resolution of prior authorization requests.
  • Assist in providing formulary alternatives and communicate prior authorization criteria, and discuss pharmacy benefit coverage inclusions/exclusions when required.
  • Interface with physicians, physician office staff, contracted pharmacists, patients, and other cross-functional team members during the prior authorization process.
  • Provide drug usage history and other pertinent pharmacy benefit-related computer searches for pharmacists and Medical Director to assist in case-specific reviews and drug evaluations.
  • Assist pharmacists with drug utilization review programs, NCQA QI programs, or other assigned projects.
  • Communicate prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician office staff, medical management staff, sales, member/customer services.
  • Assist in research and resolution of physician inquiries and grievances.
  • Provide essential clinical information to BSC Member Services, Administrative Review Department, and Consumer Affairs to resolve member inquiries and grievances.
Requirements:
  • Currently in training or recently completed training but has not consistently reached production/quality standards.
  • - years' experience required.