- Where
- Point Pleasant, WV-OH, USA
- Level
- Mid
Prior Authorization Management
Complete new and renewal prior authorizations; gather clinical documentation; submit accurate payer forms; monitor determinations; communicate requests for additional information; support appeal preparation; and document final outcomes.
Patient-Assistance and Affordability Navigation
Screen for patient-assistance programs, copay support when permitted, foundation assistance, and internal resources; complete applications; obtain signatures and financial documentation; track approvals and renewals; and communicate next steps to patients.
Marshall Health Network Pharmacy Workflow
Serve as the primary operational link between both Rivers clinics and Marshall Health Network pharmacies; confirm prescription receipt; resolve missing information; coordinate payer-required routing; support internal dispensing when eligible; and maintain closed-loop communication until medication access is completed.
High-Cost and Specialty Medication Focus
Prioritize high-cost therapies, including biologics and specialty agents, as well as other medications with significant prior-authorization, specialty-pharmacy, or affordability requirements.
Patient Communication
Provide non-clinical updates regarding authorization status, required documents, pharmacy routing, assistance-program status, and next steps. Clinical questions will be escalated to the pharmacist or prescribing team.
Data Tracking and Reporting
Track volume, approval rate, turnaround time, patient-assistance activity, estimated patient savings, internal capture, leakage reasons, abandoned prescriptions, and time to first fill. Provide routine reports to Ambulatory Clinical Pharmacy leadership.
Education:
Clinical Pharmacy Technician: Must hold or be willing to obtain National Certification or equivalent.
Experience:
Clinical Pharmacy Technician: Minimum 2 years’ experience in clinical patient care management preferred, specialty Medication experience a plus, retail pharmacy experience preferred.