Clinical Review Technician

MedOne Pharmacy Benefit Solutions; Dubuque (IA); Remote; USD 52,000 - 62,000; Full time

Benefits offered by this job

Competitive salary

Health insurance

401(k) with company match

Paid time off

Job summary

MedOne Pharmacy Benefit Solutions is seeking a Clinical Review Technician to support the MedOne Clinical Services team. You will work under the supervision of the licensed pharmacist to conduct clinical assessments and communicate decisions to providers and pharmacies.

The role emphasizes accuracy, teamwork, and the ability to work independently in a remote or in-office setting. This position offers opportunities for growth within a nationwide PBM and requires CPhT or state certification and

Qualifications

• CPhT certification or state equivalent at date of hire.
• High school diploma or equivalent required; higher degree preferred.

Responsibilities

• Support operations of MedOne Clinical Services.
• Conduct clinical assessments to evaluate medication therapy appropriateness as part of clinical review/Prior Authorization.
• Communicate clinical review decisions to pharmacies and providers.
• Maintain quality and productivity standards for all cases reviewed and meet turnaround times.
• Complete Proactive Prescriber Outreach Program (PPOP) calls and requests as assigned.
• Provide mentorship to the Data Entry Specialist team as required.
• Assist Member Advocate and Account Management teams with patient/provider requests not requiring pharmacist intervention.
• Promote a collaborative team environment.
• Support operation and maintenance of MedOne Clinical Service.

Skills

CPhT certification

Attention to detail

Time management

Customer service

Independent work

Education

High school diploma or equivalent

Tools

Microsoft Office

Microsoft Dynamics

Job description

The Clinical Review Technician works under the supervision of the licensed pharmacist on duty during day-to-day operations and reports directly to the Clinical Review Technician Supervisor. The Clinical Review Technician will perform clinical functions in supporting the daily operations of MedOne Clinical Services.

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
• Conduct clinical assessments to evaluate the appropriateness of medication therapy as part of the clinical review/prior authorization process
• Communicate clinical review decision to pharmacies and providers
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements
• Complete Proactive Prescriber Outreach Program (PPOP) calls and requests as assigned
• Provide mentorship to the Data Entry Specialist team as required
• Assist Member Advocate and Account Management teams with patient or provider requests not requiring pharmacist intervention
• Works to promote a team environment
• Support the operation and maintenance of existing MedOne Clinical Service
• 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:

• CPhT certification, or state equivalent at date of hire
• High school diploma or equivalent (Associate's or Bachelor's degree preferred)
• 1-3 years of experience in healthcare, pharmacy, insurance, or prior authorization support
• 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)
• Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint)
• 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

Why Join MedOne?

• Competitive salary and bonuses that reward your performance
• Comprehensive health, dental, and vision insurance
• 401(k) with company match to secure your future
• Generous paid time off and holidays
• Opportunities for professional growth and development
• A vibrant and collaborative work culture

Location:

We have offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States

Employment Type:

Full-Time, Hourly/Non-Exempt

Hours:

Hours may vary within our normal business hours