Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

• Determines appropriateness for medications. Communicates decision to physicians, physician`s office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system.


• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician`s office staff, medical management staff and/or pharmacists.


• Escalates requests to Pharmacist when request requires extensive clinical review or denial.


• Monitors telephone system to ensure adequate staffing to maintain client services levels.


• Assesses training needs within the team. Serves as a training resource, mentor and coach to others. Identifies and shares best practices.


• Demonstrates, advocates and reinforces a positive team environment.


• Other duties as assigned.

Responsibilities
Must have an active pharmacy technician licensure or registration in accordance with state requirements.

If state does not require an exam for licensure/registration, must possess both active pharmacy technician licensure or registration in accordance with state requirements AND an active national certification (e.g., PTCB or ExCPT).

In states that do not require licensure or registration, must have an active national certification (e.g., PTCB or ExCPT).

Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.

In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).

Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.

Excellent written and verbal communication skills.

Ability to follow clinical criteria and instructions to approve prior authorization requests.

Minimum of 2 years dispensing or retail experience required, or equivalent internal training will be substituted.

Ability to identify and trouble-shoot problematic issues.

General Job Information

Title
Clinical Pharmacy Technician

Grade
18

Work Experience - Required
Pharmacy

Work Experience - Preferred

Education - Required
GED, High School

Education - Preferred

License and Certifications - Required
CPT/ExCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

License and Certifications - Preferred

Salary Range

Salary Minimum:
$34,295
Salary Maximum:
$51,445

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.