Medical Component Clinical Specialist

Descripción del Empleo:
RESPONSIBILITIES Constantly monitors BACMAN Alert Application to ensure proper management of prior authorizations of Medical Component Drugs.

Change Alert status to approved or denied when coverage determinations evaluations are completed.

Evaluate on an individual basis coverage determinations to determine if the patient meets the criteria outlined in the guidelines or evaluation form and/or client’s stipulations.

Evaluate all administrative criteria regarding wastage, adherence and any other criteria developed from time to time.

Make outbound calls to pharmacies, physicians and beneficiaries if necessary about coverage determinations decisions as stipulated by clients and/or PharmPix policy and procedures.
Requisitos:
EDUCATION Pharmacy Associate Degree. TRAINING Puerto Rico Board of Pharmacy Technician Certification.

EXPERIENCE

3 - 5 years in Medical Component pharmacy clinical coverage determination.

SKILLS

Strong customer service skills.

Excellent phone, written, listening and follow-though skills.

Skill in analyzing situations accurately and taking effective action.

Attention to details.

Demonstrated effective organizational and communications skills.

Time Management Skills: Establishing priorities and accomplishing tasks in a timely manner.