Clinical Services Specialist

KPH Healthcare Services • East Syracuse, NY

2d • $18 - $19

About The Position

Overview 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
• Required: National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.
• Drug test
• Initial and continuous exclusion and sanction/disciplinary monitoring
• Any and all additional eligibility requirements based on the specific position
• 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

Nice To Haves

• Preferred: 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees