- Highmark Health (Sacramento, CA)
- …clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to ... requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. +...billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and… more
- Owens & Minor (Torrance, CA)
- …; Knowledge in pharmacy regulations and documentation; Knowledge in pharmacy compliance issues; Knowledge in prescription authorization processes. Utah ... related factors such as experience, skills, education and location. Description: Licensed Pharmacy Technician works under the supervision of a pharmacist and is… more
- Providence (Mission Hills, CA)
- …schedules appointments as necessary. Responsible for processing and follow up of prior authorization requests for medical group providers. Provides excellent ... customer service to patients, pharmacy personnel, clinical staff, and providers. Providence caregivers are...them. **Required qualifications:** + Coursework/Training: Complete coursework to obtain Pharmacy Tech License. + HS Diploma or GED. +… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- … prior authorizations, step therapy, and specialty drug restrictions. . Determine whether prior authorization reviews are handled by the payer directly or by ... of Rx BINs, PCNs, Group numbers, and payer identification. . Understanding of prior authorization routing and third-party review processes. . Experience with… more
- Sharp HealthCare (San Diego, CA)
- …encompasses a patient centered care management approach that includes referral management, prior authorization , Case Management and Disease Care Management and ... for the execution and coordination of all ACM activities including Pharmacy . Helps to plan, develop, organize, monitor, communicate and recommend modifications… more