Primary Responsibilities:
- Decisioning and processing member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Work is computer based and include receiving phone calls from prior authorization pharmacy technicians and/or providers for clinical information
- Consult physicians/providers with questions, interpret clinical guideline criteria, and render/review coverage determination for prior authorization cases
- Consult with pharmacy technicians and/or physicians regarding use of medications and advise of appropriate formulary alternatives when requested.
- Gather complex clinical information, coverage policy and criteria information and work within regulatory guidelines to make coverage determinations
- Organize workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards
Minimum Education Requirement:
Bachelors or Doctorate of Pharmacy
Active Iowa State Pharmacist License