Centene Corporation Pharmacy Technician II in Fresno, California
Position Purpose: Track and triage all coverage determination requests for prior authorizations and Medicare Part D recipients
- Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required
- Obtain verbal authorizations and request detailed clinical information from prescribers
- Approve coverage determination requests based on defined criteria
- Enter and document coverage determination request decision into the PBM system and notify providers and/or members
- Respond to client inquiries regarding authorization approvals and PBM on-line applications
- Refer coverage determination requests for specialty drugs to delegated vendor or client for processing
- Contact providers for additional information to facilitate coverage determination reviews
- Notify physicians, providers and members of coverage determination request decisions
Education/Experience: High school diploma or equivalent. 1 years of retail, hospital or mail order pharmacy experience.
License/Certification: Current state s Pharmacy Technician license and National Certification.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Job: Health Insurance Operations
Organization: Envolve Pharmacy
Requisition ID: 1060908