Title- Pharmacy Services 2 Duration- 5 months Remote Shift- 9-5pm Summary:The main function of Pharmacy Services is to provide efficient and accurate responses to external customers physicians, office staff, pharmacy providers, members and brokers and internal team members. Resolves outpatient pharmacy benefit coverage inclusionexclusion, prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and groupmember eligibility problems. Researches and solves administrative review and consumer affairs issues.
Job Responsibilities: Under general supervision, coordinates, assists in and supports implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit. Communicates with the physician, physicians office staff, medical management and other Blue Shield team members to assist with accurate and efficient resolution of prior authorization requestsAssists in providing formulary alternatives and communicates prior authorization criteria, and discusses pharmacy benefit coverage inclusionsexclusions when requiredInterfaces in a courteous and professional manner with physicians, physician office staff, contracted pharmacists, patients, and other Blue Shield team members during the prior authorization processProvides 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.Assists pharmacists with drug utilization review programs, NCQA QI programs or other assigned projectsCommunicates prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physician, physician office staff, medical management staff, sales, membercustomer servicesAssists in research and resolution of physician inquiries and grievancesProvides essential clinical information to BSC Member Services, Administrative Review Department and Consumer Affairs to resolve Member inquires and grievances
Education and Experience:Currently in training or recently completed training but has not consistently reached productionquality standards 24 years experience required.
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $17.00/hr.
