Clinical Services Specialist
KPH Healthcare Services•Gouverneur, NY
3d•$18 - $19
About The Position
Scope of Responsibilities: Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks. Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.
Requirements
- Must be available, and on-time for scheduled work shifts
- Minimum: High School Diploma (or currently enrolled) or GED
- National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.
- Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting
- Strong Organizational Skills
- Proficient in using Microsoft Excel, Word, and Access
- Must be able to work independently
- Drug test
- Initial and continuous exclusion and sanction/disciplinary monitoring
- Any and all additional eligibility requirements based on the specific position
Nice To Haves
- AS Degree or Higher
- hospital or retail pharmacy experience preferred
Responsibilities
- Oversee the prior authorization process to maintain efficiency and timeliness.
- Review prior authorization requests based on currently-available guidelines
- Provide Help Desk support, where appropriate, for questions regarding overrides or system edits
- Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate
- Assist in preparation of member mailings for various cost containment/clinical programs.
- Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications
- Maintain records of all prior authorizations completed by ProAct
- Providing reports on monthly basis
- Providing data for Accounting Department for invoicing
- Assist in the development and updating of formulary documents
- Responsible for completing all mandatory and regulatory training programs
- Assist with the day-to-day operations of the ProAct Help Desk
- Perform other duties as assigned
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
