Pharmacy Operations & Prior Authorization Coordinator

IMCS Group; California; On-site; USD 42,000 - 64,000; Full time

Job summary

IMCS Group is seeking a Pharmacy Technician to support health plan pharmacy operations in California. The role focuses on prior authorization, formulary management, and responding to provider/pharmacy inquiries with accuracy and compliance.

The candidate should have 3+ years of pharmacy experience in a managed care setting, with Medicare/Medicaid exposure and a valid PTCB certification or ability to obtain within 30 days.

Qualifications

• High school diploma or equivalent. 3+ years of pharmacy experience, preferably in a managed care environment.
• Medicare and/or Medicaid experience preferred.
• Previous experience in call center or fast paced pharmacy answering multi-line phone system preferred.
• Current state's Pharmacy Technician license and PTCB or ability to obtain within 30 days.

Responsibilities

• Receive and respond to provider and pharmacy calls regarding the prior authorization and formulary process
• Perform review of pharmacy and override process in compliance with pharmaceutical related company and State guidelines
• Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns
• Resolve complaints and grievances related to the pharmacy network in conjunction with the Pharmacy team
• Assist Provider Relations and various departments with educating providers on the health plan's pharmacy process
• Assist with the pharmacy utilization review and reporting process
• Collaborate with Quality Improvement department with various meeting preparation and transcription of minutes
• Assist with members' inquiries related to the formulary process
• Performs other duties as assigned
• Complies with all policies and standards

Skills

Pharmacy experience

Call center

Multi-line phone system

Education

High school diploma

PTCB certification

Tools

Analysis tools

Job description

IMCS Group is seeking a Pharmacy Technician to support health plan pharmacy operations in California. The role focuses on prior authorization, formulary management, and responding to provider/pharmacy inquiries with accuracy and compliance.

The candidate should have 3+ years of pharmacy experience in a managed care setting, with Medicare/Medicaid exposure and a valid PTCB certification or ability to obtain within 30 days.