Helping make health care for Californians easy, accessible and reasonably priced
is a great calling. Knowing that your company has channeled over $100 million
back into California communities and will continue to do so is flat out
uplifting. Join the hardest working, not-for-profit health plan in California
and be part of the solution.

Provides efficient and accurate responses to external customers (physicians,
office staff, pharmacy providers, members and brokers) and internal team
members. Resolves outpatient pharmacy benefit coverage (inclusion/exclusion),
prescription claim problems, communicates drug formulary guidelines including
drug formulary alternatives, prior authorization criteria and group/member
eligibility problems. Researches and solves administrative review and consumer
affairs issues.

Responsibilities:

Coordinates, assists in and supports implementation of procedures and guidelines
for the drug prior authorization program for the outpatient Pharmacy Benefit.
Develops an interface with the physician, physician s office staff, medical
management and other Blue Shield team members to ensure accurate and efficient
resolution of prior authorization...

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