Published: November 9, 2019
- Process member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Navigate across multiple computer systems to respond to questions or to provide specific medication details/clinical information
- Receive incoming calls from members or providers and conduct outgoing calls as needed to provide follow-up or consultation such as prior authorization requirements, appeals, etc.
- Apply benefit plan criteria when making decisions (approvals/denials) or recommendations
- Educate members and providers on pharmaceutical benefits
- Partner with others to gather additional information and/or to interpret clinical guidelines.
- Valid, unrestricted Puerto Rico Pharmacy Technician license or National Pharmacy Technician Certification (PTCB), or ability to obtain license within 6 months of hire
- Proficiency with computer and Windows PC applications including ability to navigate and learn new and complex computer system applications
- Ability to identify problems including complex issues and determine solutions, both independently or in a team/group setting
- Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed
- Professional proficiency in both English and Spanish. Please note that an English proficiency assessment will be required for his position.