Clinical Specialist - Part Time

MedImpact•Fremont, NE

2d•Onsite

About The Position

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. Essential Duties and Responsibilities include the following. Other duties may be assigned. 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. 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; Supervisory Responsibilities This job has no supervisory responsibilities. Client Responsibilities 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.

Requirements

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas
Strong computer skills with Microsoft Office and Microsoft Outlook; good working familiarity with databases and internet searches.
Current, unrestricted license as a Registered Pharmacist in any state of the United States required.
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.
Knowledge of Microsoft Office Suite Word Processing software.
Current, unrestricted Registered Pharmacist license in the State of California or a 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 solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
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

Responsibilities

Providing clinical review support services to client plan(s) contracting for clinical services.
Reviewing prior authorization requests and either deciding to approve or deny the request.
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.
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.
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.
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.