Job Description:
The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to outbound calls, reviewing and processing Prior Auth's received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria def...