Clinical Specialist - Pharmacist-1

MedImpact•Fremont, NE

13d•$52 - $94•Onsite

About The Position

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 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.

Requirements

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas
To perform this job successfully, an individual should have knowledge of Microsoft Office Suite Word Processing software.
Current, unrestricted Registered Pharmacist license in any state of the United States.
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.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy
This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Responsibilities

Responsible for providing clinical review support services to client plan(s) contracting for clinical services. This includes reviewing prior authorization requests and either deciding to approve or deny the request.
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.
Review medication request guidelines for clinical appropriateness and operational efficiency.
Assist in the revision and creation of new or existing medication request guidelines as indicated.
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.
Provide drug information support.
The position may also need to follow general guidance from the client on the handling of specific request types (non-formulary, quantity exceptions, etc.)
Research and provide clinical literature documentation to support prior authorization decisions as indicated.
May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review.
Coordinate and assist in the preparation of utilization and compliance reporting for client plans.
Ensure timely preparation and review of plan data and client presentations, when required.
Coordinate and assist with projects associated with prior authorization program development, implementation and internal and external communications.
Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists.
Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.
Assist with training to support growth of the Prior Authorization Department.
Handling Provider, Pharmacy and member calls to complete prior authorization and Peer to Peer requests based on client specific requirements.
Assist in identifying clinical program eligibility and referral to clinical programs
Assist in maintaining clinical programs, including clinical program ownership, client reporting, participant communication and account management support.
Assist in the implementation of new clients onboarding which may include medication audits and grandfathering of medications and being the clinical liaison to the new client.