• Facilitate the onboarding process for new hires and provide comprehensive training sessions for pharmacists on prior authorization systems, processes, and procedures utilizing a variety of training methods.
• Develop and update training materials, resources, verbiage templates, job aids, and communicate updates to the team.
• Ensure that training content is accurate, up-to-date, clinically relevant, compliant with federal and state regulations, and internal policies.
• Maintain detailed records of training sessions, participant attendance, and training materials for auditing and reporting purposes.
• Assess performance of pharmacists through evaluations, quizzes, and practical assessment to identify areas for improvement and provide constructive feedback.
• Collaborate with pharmacy managers, supervisors, and other relevant stakeholders to identify training needs, performance gaps and ensure alignment with company goals.
• Make clinical prior authorization and appeals determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.
• Provide detailed and thorough documentation in prior authorization cases, overrides and call center cases.
• Perform peer-to-peer reviews with providers when requested.
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
• Effectively communicate issues and resolutions to members, pharmacies, providers, and appropriate internal stakeholders.
• Provide backup support to call center team as required.