Dec '25 • General discussion
Pharmacy Operations Specialist
- Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements
- Properly apply clinical policy criteria to the review of prior authorization requests
- Review and interpret member’s eligibility, claim history, and Pharmacy Program information using the PBM claims software to provide information to both internal and external clients via telephone or email
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Pharmacy Operations Specialist
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