• 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
• Perform all duties and functions in compliance with state and federal pharmacy laws and regulations
• Conform with and supports department quality assurance and improvement guidelines
• Dedication to build rapport with coworkers, internal customers, and other departments by demonstrating a strong customer service orientation and a continuous positive image of OptumRx.
• Demonstrate ability to maintain productive working relationships with team members, other internal and external customers, and management team.
• High School Diploma or GED is required
• Associates degree or 3-5 years of equivalent work experience is preferred
• 1 - 3 years of previous experience as a Pharmacist is preferred
• 1 year of customer service experience analyzing and solving customer problems, OR 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties is preferred.
• 1 to 3 years of PC skills (MS Word, Excel) proficiency is preferred
mthum@judge.comPHONE
/TXT:(484) 753-3515
mthum@judge.com
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