Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We’ve stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients’ success.

*THIS IS A CALL CENTER & CANDIDATE WILL BE TAKING INBOUND CALLS IN A HIGH VOLUME CALL CENTER*

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribes received by telephone and/or facsimile using client clinical criteria.

***AVAILABLE TO WORK ANY SHIFT MONDAY - SUNDAY; 9:00 AM-8:30 PM. WILL HAVE 2 DAYS OFF.

***NATIONAL CERTIFICATION (PTCB) REQUIRED***

ESSENTIAL FUNCTIONS:

• Determines appropriateness for medications. Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists.
• Researches, resolves and documents prior authorization outcomes in pharmacy system.
• Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists.
• Escalates requests to Pharmacist when request requires extensive clinical review or denial.
• Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
• Performs other duties as required.
• Ability to identify and trouble-shoot problematic issues.

• CPT: Certification/ licensure in accordance with state requirements.
• Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting.
• In-depth knowledge of specialty injectable prescription drugs, disease states, health plan formulary
• management techniques, medical terminology and current diagnostic and reimbursement coding (J/Q codes, ICD-9, CMS 1500, etc.).
• Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite.
• Excellent written and verbal communication skills.
• Ability to follow clinical criteria and instructions to approve prior authorization requests.
• Minimum of 6 months dispensing or retail experience required, or equivalent internal training will be substituted.
• Ability to identify and trouble-shoot problematic issues.

All your information will be kept confidential according to EEO guidelines.