Clinical Pharmacy Coordinator (Remote)

MRIoA•Mountain View, CA

4d•Remote

About The Position

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. Our Clinical Pharmacy Coordinator is responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming pharmacy review requests, preparing review information and materials for assignment to appropriate reviewers, entering pharmacy case review data in the online case summary/tracking system, receiving and reviewing Reviewer decisions, completing outreach over the phone to gather additional information for cases, taking inbound phone calls from medical professionals, issuing appropriate, timely and accurate review outcome notifications and completion of pharmacy case review data in the online case summary/tracking system and client system.

Requirements

Minimum of one year pharmacy experience preferred
Minimum of one year in a similar operation preferred (health insurance, healthcare and/or managed care arena) preferred
Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities
Ability to work independently with minimal supervision
High level of adaptability, evidenced by the ability to thrive in dynamic environments and rapidly adjust to shifting priorities
Personal computer literacy and high competency in use of Microsoft Word
Strong organizational skills with attention to details
Strong oral and written communication skills
Well-developed training skills
Strong working knowledge of basic anatomy, physiology and medical terminology preferred
Strong working knowledge of medical insurance terminology and processes preferred
Strong working knowledge of prescription drug terminology preferred
Excellent critical thinking capabilities with a strong attention to detail
Exceptional customer service skills
Thorough understanding and knowledge of Company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards.

Responsibilities

Prepare high quality appropriate pharmacy case review information and materials for submission to the reviewers
Finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
Serve as a company liaison with clients, reviewers and practitioners/providers/facilities whose services are subject to review
Screen incoming pharmacy review requests for completeness of materials required to conduct the review of the case
Prepare, organize, distribute and present records, materials and forms required for a complete pharmacy case review by reviewers
Identify appropriate reviewers for pharmacy case review assignment including: determine their availability for a review assignment and obtain information for delivery of the case to the Reviewer if applicable
Contact clients to resolve questions, obtain information, records and/or materials needed for a pharmacy case review and resolve issues about active cases
Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
Receive incoming phone calls from medical professionals checking status on cases and/or providing additional information to decision cases
Create and maintain an in-house review file for each active pharmacy case
Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling as needed
Research clients’ questions about review processes and/or Reviewer decisions
Determine the need for additional information or additional review and notify the client and internal departments of these needs
Support all Quality Management initiatives
Actively participate in the compliance process and Provider Relations assessment process
Support all compliance program activities
Participate in all company meetings and committees as requested
Adhere to all policies and procedures
Take feedback and responsibility for performance
Adapt to the differences of clients
Maintain a flexible schedule to meet client needs
Complete other duties and responsibilities as directed
Collaborate with and cross-train on other teams as needed