• Support initiatives to resolve gaps in care through direct provider and member outreach • Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia • Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence • Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach • Identify and resolve same-day grievances reported by members in a timely manner

• takes in-bound calls from providers, pharmacies, members, etc. providing professional and courteous phone assistance • maintains complete, timely and accurate documentation of reviews • transfers all clinical questions, escalations and judgement calls to the pharmacist team • assist with outbound calls, reviewing and processing Prior Auth’s received via fax and ePA • monitoring and responding to inquiries via department mailboxes • complies with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information • communication with other internal groups regarding determination status and results • identify and elevate clinical inquiries to the pharmacist team as appropriate.

• Accurately and efficiently enter new orders and refill orders • Properly handle order exceptions such as refill-too-soon, invalid orders, etc. • Handle inbound and outbound calls with other facilities • Identify orders that are valid and those that are invalid, and carry out appropriate order entry and workflow • Adjudicate insurance claims and resolve rejections • Initiate and follow through on refill requests with prescribers • Triage and troubleshoot requests from prescribers and customers • Proactively identify challenges and resulting solutions quickly and follow through on plan of action • Communicate with prescribers, caregivers, leadership, and peers to work effectively together to meet deadlines • Achieve or exceed productivity standards in a fast-paced environment • Stay adherent to Onboarding deadlines and follow through on designated tasks • Package Tracking via Fedex and Courier Services • Become familiar with common EMAR programs (Therap, QuickMAR) and coordinate pharmacy transfers • Perform Facility Training to various audiences to educate on pharmacy processes and online portal

• Responsible for the clinical evaluation and determination of client UM requests. • Accountable for direct consultation with health care providers concerning non-formulary and clinical product coverage issues. • Collaborate with team members to promote consistency of clinical decisions across the pharmacist team. • Other duties as assigned.