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. Disclaimer 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.
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Job Type
Full-time
Career Level
Mid Level
Industry
Religious, Grantmaking, Civic, Professional, and Similar Organizations
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees