About Us:
TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.
Minimum Qualifications
Possess an Associate’s Degree in a health related field (i.e., Medical Assistant) or a certification as a Pharmacy Technician
Have experience working for a Pharmacy Benefit Management (PBM) company or health plan in a managed care pharmacy department; working knowledge of retail pharmacy third party prescription processing.
Have knowledge of drug categories, brand and generic names including pronunciation and spelling; knowledge of utilization management tools used for controlling pharmacy costs – i.e. quantity limits, prior authorization, step therapy, generic programs, etc.
Ability to have a professional dialogue with a physician or a physician’s staff.
Basic computer skills to include, but not limited to, Microsoft Office Products.
Role Description:
Process prior authorization requests. Issue prior authorizations as appropriate through established protocols, policies and procedures.
Communicate with the physicians’ and pharmacies’ approvals and denials by phone and/or letter as needed.
Answer questions/requests and resolve issues from providers, pharmacists and staff. The resource will field questions regarding pharmacy benefit issues and communicate details of service through telephonic responses to physicians, pharmacists and Commonwealth staff. Issues addressed include prescription benefits, formulary issues, prescription claim processing, and prior authorizations.
The resource ensures documentation of actions. Resolve routine provider pharmacy concerns. This includes answering questions from various sources (a member, physician, staff, etc.) regarding specific provider issues and as appropriate deciding on plans of action to resolve routine issues.
Provide administrative support to the pharmacy team. This involves preparation and distribution of Policies & Procedures, committee agendas and minutes, and other correspondence as required. Document all communications appropriately.
This includes documentation through the telephone call tracking system.
TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com
Source: Indeed.com
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