Location: Remote Remote Location: # of openings: 2 Department: Employment duration: Full time Exemption Status: Non-Exempt Relocation Assistance: N/A Added to system: 7/19/23 11:15 AM Job Code: 2520.230719.8286

Description

Clinical Specialist Wyoming

$104,342 – $146,600 - $188,858

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

The Scoop:

The Clinical Specialist manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions.

What You Get To Do:

• May consult regarding a PA request directly with a client representative or an internal Subject Matter Expert or contact a dispensing pharmacist, prescriber, or prescriber representative to obtain additional information
• Research and provide clinical literature documentation to support prior authorization decisions as indicated
• Reviews medication request guidelines for clinical appropriateness and operational efficiency
• Responsible for providing clinical review support services to client plan(s) contracting for clinical services
• Provides in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process
• Coordinates and assists in the preparation of utilization and compliance reporting for client plans
• Support services also include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and requests as required by client contracts and Utilization Management delegation agreements
• Provides feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review
• Assist in the revision and creation of new or existing medication request guidelines as indicated
• This includes reviewing prior authorization requests and either deciding to approve or deny the request
• This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists
• The position may also need to follow general guidance from the client on the handling of specific request types (non-formulary, quantity exceptions, etc.)
• Coordinates and assists with projects associated with prior authorization program development, implementation, and internal and external communications
• Ensure timely preparation and review of plan data and client presentations, when required
• Provides drug information support

Supervisory Responsibilities

This job has no supervisory responsibilities.

Education and/or Experience

For consideration candidates will need a Pharmacy degree (Pharm. D.) (or equivalent combination of education and experience such as Bachelors, Pharmacy) and two (2) – five (5+) years’ related experience.

Computer Skills

To perform this job successfully, an individual should have knowledge of Microsoft Office Suite Word Processing software.

Certificates, Licenses, Registrations

Current, unrestricted Registered Pharmacist license in the United States as applicable to client requirement.

Other Skills and Abilities

Excellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment. Expertise in clinical application of pharmacy practice.

Travel

This position requires no travel; however, attendance may be required at various local conferences and meetings.

The Perks:

• 401K with Company match
• Life and Disability Insurance
• Paid Time Off / Company Paid Holidays
• Medical / Dental / Vision / Wellness Programs
• Tuition Reimbursement
• Employee Referral Bonus

This position is eligible for Employee Referral Bonus at Level IV

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.