GET TO KNOW ALORICA
At Alorica, we only do one thing – make lives better, one interaction at a time. We’re a global leader in customer service and experience, serving the world’s biggest brands with tens of thousands of employees in hundreds of locations around the globe.
Support industry leading healthcare companies in prior authorization, clinical appeals, mail order, prescriber education, patient counseling, drug information and customer services.
• Accurately interprets and verifies physicians' prescriptions, accesses, inputs and retrieves prescription information from the computer system, verifies whether the order is within program guidelines.
• Reviews and approves/denies requests for prescription prior authorizations.
• Review initial physician requests according to published policies and procedures, applicable clinical criteria, and regulatory and compliance requirements.
• Provide phone coverage in accordance with call center policies and procedures.
• Process requests for insurance coverage of formulary and non-formulary drugs that reject at the dispensing pharmacy based on pre-determined plan criteria.
• Plan criteria setup based on evidence based medicine and includes the exercise of appropriate clinical judgment.
• Review all adverse coverage determinations before final decisions are rendered and as required by law.
• Work in conjunction with medical directors to render final decisions on coverage determinations.
• May oversee the activities of pharmacy technicians, pharmacy clerks and customer service representatives.
• Organizes workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards. This is a production role.
• Conforms with and supports department quality assurance and improvement guidelines.
OTHER RELATED DUTIES
JOB REQUIREMENTS Minimum Education and Experience:
• Responsible for understanding and complying with all policies, procedures, and regulations relating to job duties.
• Perform other duties as assigned by management.
• Pharmacist Licensure must be current and unrestricted (or must be acquired within 30 days of employment); B.S. in Pharmacy and/or PharmD degree from accredited School of Pharmacy.
• At least one year experience working in a retail pharmacy setting preferred.
Knowledge, Skills and Abilities:
• Understanding of and the ability to apply all state and federal laws and regulations related to the practice of pharmacy.
• Ability to adhere to safety rules and regulations and maintain the confidentiality of patient and department information.
• Ability to navigate MS Office and a Windows based environment and the ability to create, edit, save, and send documents utilizing Microsoft Word.
• Ability to navigate Outlook and conduct Internet searches.
• Ability to collaborate with other health care professionals.
• Excellent interpersonal, written, and oral communication skills.
• Ability to prioritize and organize work in a multitasked environment.
• Ability to adapt to a flexible schedule.
• Ability to maintain the highest level of confidentiality.
• Office environment.
• Ability to lift and/or move 20 pounds with or without accommodation.
Alorica is an equal opportunity employer and committed to diversity in its workforce. Alorica recruits qualified applicants and makes all employment-related decisions based exclusively on job-related qualifications, without regard to characteristics such as race, color, national origin, religion, gender, age, marital status, disability, veteran status, citizenship status, sexual orientation, gender identity, or any other status protected by law.