Remote Clinical Specialty Review Pharmacist

MedOne Pharmacy Benefit Solutions; Dubuque (IA); Remote; USD 130,000 - 170,000; Full time

Benefits offered by this job

Health Insurance

Dental Insurance

Vision Insurance

401(k) Match

Paid Time Off

Professional Growth

Collaborative Culture

Job summary

MedOne Pharmacy Benefit Solutions is seeking a Clinical Specialty Review Pharmacist to evaluate clinical criteria and render coverage determinations for complex specialty therapies such as oncology and autoimmune diseases.

The role includes outbound consultations with physicians and patients, literature reviews to support decisions, and rigorous documentation in all cases, while aligning with medical necessity and benefit guidelines.

Qualifications

• Experience in managed care, specialty pharmacy, clinical review, utilization management, or prior authorization operations.
• Proficient in MS Office; familiarity with clinical resources (Micromedex, Lexicomp, Clinical Pharmacology).
• Ability to translate clinical information for clinical and non-clinical audiences.

Responsibilities

• Evaluate and interpret clinical guideline criteria to render coverage determinations for specialty medications.
• Perform outbound clinical consultation calls with physicians, providers, and patients regarding coverage questions.
• Conduct literature evaluation to support decisions beyond guidelines.
• Document thoroughly in prior authorization and appeal cases.

Skills

Clinical review

Utilization management

Prior authorization

Communication skills

Time management

Independent work

Microsoft Office

Microsoft Dynamics

Tools

Micromedex

Lexicomp

Clinical Pharmacology

Microsoft Dynamics

Job description

MedOne Pharmacy Benefit Solutions is seeking a Clinical Specialty Review Pharmacist to evaluate clinical criteria and render coverage determinations for complex specialty therapies such as oncology and autoimmune diseases.

The role includes outbound consultations with physicians and patients, literature reviews to support decisions, and rigorous documentation in all cases, while aligning with medical necessity and benefit guidelines.