- Prepare prior authorization requests by validating prescriber and member information and checking clinical guidelines.
- Make outbound calls to providers to obtain additional clinical information for pharmacist review.
- Proactively obtain clinical information from prescribers and referral coordinators.
- Review and analyze pharmacy claims data for proactive outreach and intervention.
- Identify, document, and escalate provider concerns to the appropriate internal team.
- Triage phone calls from members, pharmacy personnel, and providers using drug and client-specific clinical questions.
- Communicate issues and resolutions to members, pharmacy staff, and stakeholders.
- Follow internal Standard Operating Procedures and adhere to HIPAA guidelines.
HIPAA