Remote Clinical Review Specialist

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

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