• Support standardization and optimization of specialty pharmacy services across Bon Secours Mercy Health • Ensure proper processing and problem solving of specialty medications and other medications supported by pharmacy • Provide excellent customer service via phone and occasional direct patient contact • Receive patient prescriptions, review medication list with patients, answer phones, and triage phone calls • Help maintain the pharmacy in proper order and ensure accurate billing of third-party payer plans • Assist patients in receiving medications at the lowest cost and facilitate third party billing • Work closely with patients, providers, and the specialty pharmacy team

• Collaborates with the technicians and prior authorization team members to process referrals • Evaluate and review all prior authorization requests and render coverage determinations • Guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals • Performs and handles inbound and outbound phone calls to facilitate prior authorization requests • Establishes and maintains communication among CVS Caremark, health plan, and employer group staff • Maintains professional and technical knowledge of drug and disease states • Performs other related projects and duties as assigned

• Deliver rapid quality and process improvement information to the technicians on their team • Prepare material for and deliver in team meetings • Serve as a subject matter expert for their team • Provide guidance to pharmacy technicians on quality assurance monitoring and productivity standards • Track and triage coverage determination requests submitted from providers • Obtain verbal authorizations and request detailed clinical information from prescribers • Approve coverage determination requests based on defined criteria • Document coverage determination request decision into the PBM system and notify providers and/or members • Respond to client inquiries regarding authorization approvals and PBM on-line applications • Refer coverage determination requests for specialty drugs to delegated vendor or client for processing • Perform other duties as assigned

• Provide integrated support to pharmacy staff and Shields Health Solutions Liaisons • Ensure accurate and timely filling and delivery of specialty medications • Place outbound calls to patients and assist them through the refill process • Answer, resolve and triage inbound inquiries • Clarify prescription orders with pharmacist and/or clinician • Proactively coordinate medication refills including data entry • Manage, organize, and update relevant data using database applications • Participate in process improvement initiatives