Aetna Pharmacy Tech-Call Center in Houston, Texas
Req ID: 51297BR
Evaluates, authorizes approval, and communicates decisions for prior authorization pharmacy requests according to clinical guidelines.
Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. Determines appropriateness for medications. Communicates decision to physicians, physicians office staff, medical management staff, and/or pharmacists. Communicates selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physicians office staff, medical management staff, and/or pharmacists. Researches, resolves, and documents prior authorization outcomes in the pharmacy system. Escalates requests to Pharmacist when request requires extensive clinical review or denial. Researches, resolves, and documents physician or client inquiries and grievances. Provides verbal or written results to client, prescriber, provider, and/or management. Performs other duties as required.
6 months experience in retail, hospital, or facility pharmacy setting required.
Proficiency in computerized pharmacy systems and software applications required.
Excellent verbal and written communication skills.
Ability to follow clinical criteria and instructions
Experience with Windows-based software applications.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
LICENSES AND CERTIFICATIONS
Pharmacy/Pharmacy Technician is desired
Functional - Customer Service/Customer Service - Pharmacy/1-3 Years
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care