Pharmacist

• Perform technical tasks within the pharmacy department of the Health Plan under general supervision of the pharmacy technician supervisor
• Answer inbound phone calls
• Make outbound phone calls
• Process faxed, electronic, or verbal prior authorizations
• Perform basic computer system operations
• Work competently in different areas of pharmacy practice
• Apply call center functions and etiquette when taking or making phone calls
• Document all inbound and outbound phone calls
• Implement prior authorization decisions based on criteria and send to clinical review when appropriate
• Triage and escalate prior authorizations, questions, or issues outside the pharmacy technician scope of practice to the direct supervisor or pharmacist on duty

Pharmacy Technician II

• Administer prior authorization requests for patients whose health plans require drug prior authorizations
• Review the accuracy and completeness of prior authorization information
• Ensure supporting documents are present and meet company standards
• Assist with medical necessity documentation to expedite approvals
• Perform appropriate follow-up
• Collaborate with other departments to obtain prior authorizations and appeals
• Document insurance company interactions and prior authorization information in the system
• Review insurance denials and submit appeals as permitted by payors
• Contact physician offices to obtain demographic information or medical data

Pharmacist jobs in Colorado

Pharmacy Technician II

Authorization Representative II – BioPlus Specialty Pharmacy