Under the direct supervision of the Associate Director or designee, the Pharmacy Associate II functions as a team member of the drug utilization review programs within Clinical Pharmacy Services (CPS). CPS is responsible for administering client-specific programs to provide clinical expertise in regards to prior authorization for member prescriptions. This position may handle live calls from physicians and pharmacists and provides information regarding client initiatives, with increasing independence. The incumbent of this position will also review requests for prior authorization and determine approval or denial of these requests under the guidance of a licensed pharmacist.
- Review clinical documentation against applicable criteria submitted by physicians and pharmacists to determine approval or denial of request for prior authorization.
- Assist CPS staff with data entry and monitoring/researching member profiles for prior authorization requests and ad hoc reports.
- Assist CPS consultant pharmacist with obtaining and disseminating information concerning upcoming appeals.
- May provide guidance to Pharmacy Associate I in performance of duties
- Participate in orientation of Pharmacy Associate I staff members.
- May provide real time information via telephone to physicians and pharmacists regarding questions concerning initiatives involving member prescriptions.
- May decide in real time via telephone communications with pharmacies, the authorization or denial of certification requests for prescription medications.
- Participate in quality improvement initiatives within CPS.
- Attend CPS staff meetings and in-service programs as requested.
- Perform other duties as required.
Certification with 1 year pharmacy experience or 2 years pharmacy or drug utilization review experience
Under the direct supervision of the Associate Director or designee
Indirect supervision of support staff
ENVIRONMENTAL WORKING CONDITIONS:
Usual office environment