Pharmacy Specialist

Job Summary

Responsibilities

• Process prior authorizations received via prior authorization help line and fax applications by reviewing the documents, evaluating for accuracy and completeness of the medical necessity forms for specific drugs based on provided criteria.
• Submit for clinical review and determination.
• Directly interact with members, physician office staff, pharmacies, and internal stakeholders for eligibility, coverage determination, and claims issues.
• Conduct intervention with physician & pharmacy office staff to facilitate formulary compliance and generic dispensing.
• Provide recommendations to increase efficiency, accuracy, and productivity in the department.
• Process ad hoc requests for information or reports from stakeholders.
• Participate in client member and employee training to ensure practical understanding of pharmacy services programs and operations.
• Aid in the day-to-day business functions of the pharmacy department.
• Support various clinical programs within the pharmacy department.

Requirements

• National Pharmacy Certification preferred.
• Minimum of two (2) years experience in third-party prescription program claim adjudication.
• Minimum of two (2) years experience as a Pharmacy Technician.
• Prior customer service/service quality initiative experience.

Qualifications

• Education: National Pharmacy Certification preferred.
• Experience: Minimum of two (2) years experience in third-party prescription program claim adjudication.
• Experience: Minimum of two (2) years experience as a Pharmacy Technician.
• Experience: Prior customer service/service quality initiative experience.

Since 1995, iTech Solutions Inc., has been providing IT Consulting and Direct Hire Services to the Insurance, Financial, Communications, Manufacturing, and Government sectors with local offices in Connecticut, Minnesota, Colorado, Massachusetts, Tennessee, North Carolina, and New Jersey / Pennsylvania area. Our recruiting strategy is simple, if you want to find qualified IT professionals then use IT professionals to find them. So at iTech Solutions, our personnel are all career IT professionals with a wide range of IT experience. We can honestly say our staff understands the technologies, the complexities of finding and selecting the appropriate personnel and the pressures of running successful IT projects.

Employer will not sponsor applicants for any employment visas, at hiring or in the future, including but not limited to H-1B visas. Corp-to-Corp or subcontract personnel will not be considered for this position.

iTech Solutions, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.