Clinical Pharmacist

MedOne Pharmacy Benefit Solutions; Dubuque (IA); Remote; USD 60,000 - 75,000; Full time

Job summary

MedOne Pharmacy Benefit Solutions in the United States is seeking a Clinical Review Technician to support the Clinical Services Business Unit, performing coverage determinations and clinical program support. You will conduct literature reviews, document thoroughly in prior authorization and appeals cases, mentor teammates, and assist in MTM and population health initiatives.

Candidates should be proficient in Microsoft Office, familiar with Micromedex/Lexicomp, and able to work independently in

Qualifications

• Proficient in MS Office and clinical resources.
• Able to translate clinical information for clinical and non-clinical audiences.
• Strong problem-solving and attention to detail.
• Excellent written and verbal communication; able to work independently.
• Must have a dedicated quiet workspace for remote work.
• Must be able to lift up to 25 pounds.

Responsibilities

• Support operations of MedOne Clinical Services unit with responsibilities supporting the clinical review, programs, and account management departments.
• Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge when rendering coverage determinations.
• Perform outbound clinical consult calls with physicians, providers and/or patients to answer inquiries regarding determinations.
• Perform literature evaluation using primary, secondary, and tertiary drug resources to support decisions outside clinical guideline criteria.
• Provide thorough documentation in prior authorization cases, appeals cases, and overrides.
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.

Skills

MS Office

Micromedex

Lexicomp

Clinical Pharmacology

Microsoft Dynamics

Tools

Microsoft Dynamics

Job description

About MedOne:

MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.

What You Will Do at MedOne:

• Support operations of MedOne Clinical Services Business Unit with responsibilities supporting the clinical review, clinical programs, and clinical account management departments
• Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering coverage determinations (approvals, part approvals, denials)
• Perform and completes outbound clinical consult calls with physicians, healthcare providers and/or patients to as requested to answer inquiries regarding determinations
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations that are outside clinical guideline criteria
• Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements
• Provide mentorship to the Clinical Review Technician team as required
• Support Medication Therapy Management (MTM) and adherence programs
• Contribute to disease management initiatives and population health strategies
• Assist Clinical Account Managers in delivering clinical solutions to clients
• Respond to client inquiries regarding clinical programs and benefit design
• Assist in preparing presentations for client meetings and quarterly business reviews
• Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention
• Works to promote a team environment
• Support the operation and maintenance of existing MedOne Clinical Services
• Assists and supports members of MedOne Pharmacy Benefit Solutions
• Portrays the company in a positive image
• Required to abide by all rules, regulations and policies of the employer
• Other duties as assigned

What you will bring to MedOne:

• Proficient in Microsoft Office Suite and experience using clinical resources (Micromedex, Lexicomp, Clinical Pharmacology)
• Ability to translate clinical information into a manner appropriate for both clinical and non-clinical audiences
• High degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
• Detail-oriented with a high degree of accuracy
• Strong interpersonal, written, and verbal communication skills
• Ability to work independently and manage time effectively
• Excellent customer service and teamwork skills
• Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees)
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus
• Must be able to type at a minimum of 30 words per minute
• Must be able to work independently, meets deadlines, establish priorities, and be flexible
• Must be able to stand/sit for long periods of time within limited space
• Must be able to lift up to 25 pounds
• Must be able to work cooperatively with MedOne staff