Pharmacy Operations & Prior Authorization Specialist

IMCS Group; Louisville (KY); On-site; USD 38,000 - 48,000; Full time

Job summary

IMCS Group in the United States is seeking a Pharmacy Technician to support the health plan's pharmacy program. You will handle prior authorization, formulary reviews, and provider communications in a managed care setting.

The role requires a high school diploma or equivalent, 3+ years of pharmacy experience, and an active Pharmacy Technician license with PTCB, or the ability to obtain within 30 days. Prior call center experience is preferred for this fast-paced environment.

Qualifications

• 3+ years of pharmacy experience, preferably in a managed care environment.
• License/Certificate: Current state's Pharmacy Technician license and PTCB or ability to obtain both within 30 days of start date.
• Experience in call center or fast-paced pharmacy answering multi-line phone system preferred.

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 experience

Customer service

Education

High school diploma or equivalent

Pharmacy Technician license

PTCB certification

Tools

Pharmacy software

PTCB tools

Job description

IMCS Group in the United States is seeking a Pharmacy Technician to support the health plan's pharmacy program. You will handle prior authorization, formulary reviews, and provider communications in a managed care setting.

The role requires a high school diploma or equivalent, 3+ years of pharmacy experience, and an active Pharmacy Technician license with PTCB, or the ability to obtain within 30 days. Prior call center experience is preferred for this fast-paced environment.