Remote Clinical Pharmacist - Prior Auth & MTM

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

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