Pharmacy Services Intermediate

Pharmacy Services Intermediate
12 months
Remote in California

Provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members and brokers) and internal team members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines including drug formulary alternatives, prior authorization criteria and group/member eligibility problems. Researches and solves administrative review and consumer affairs issues.

• Coordinates, assists in and supports implementation of procedures and guidelines for the drug prior authorization program for the outpatient Pharmacy Benefit
•Develops an interface with the physician, physician’s office staff, medical management and other team members to ensure accurate and efficient resolution of prior authorization requests.
•Provides formulary alternatives, communicates prior authorization criteria, and discusses pharmacy benefit coverage inclusions/exclusions when required
•Interfaces in a courteous and professional manner with physicians, physician office staff, contracted pharmacists, patients, and other team members during the prior authorization process
•Provides 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 projects
•Researches and resolves physician inquiries and grievances
•Provides essential clinical information to Member Services, Administrative Review Department and Consumer Affairs to resolve Member inquires and grievances
•Assists Medical Directors and Medical Management teams of all regions to evaluate and process Home Self-Administered Injectables
•Participates in, evaluates and maintains efficient workflow procedures in accordance with the clinical programs as well as the Pharmacy Department’s goals and objectives

Education and Experience:

•AA Degree and 2 years of Pharmacy related experience and training; or equivalent combination of education and experience. State Board as Certified Pharm Tech required
 

Note: The Company 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. 

 

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. 
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.