Clinical Specialist

MedImpact Healthcare Systems • San Diego, CA

410d • $104,341 - $188,857

About The Position

The Clinical Specialist at MedImpact Healthcare Systems is responsible for managing the accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This role involves providing clinical review support services, analyzing prior authorization requests, and ensuring compliance with medication request guidelines. The Clinical Specialist plays a crucial role in enhancing the value of healthcare through effective drug therapy management and collaboration with various stakeholders.

Requirements

• Doctor of Pharmacy (Pharm. D.) or equivalent degree.
• Current, unrestricted Registered Pharmacist license in California or another U.S. state.
• 2+ years of related experience in pharmacy or clinical settings.
• Proficient in Microsoft Office Suite and word processing software.
• Excellent customer service and interpersonal communication skills.

Nice To Haves

• Experience in managed healthcare environments.
• Knowledge of pharmacy services and clinical applications.

Responsibilities

• Provide clinical review support services to client plans contracting for clinical services.
• Review prior authorization requests and decide to approve or deny them.
• Assist in the revision and creation of medication request guidelines.
• Consult with client representatives or internal experts regarding prior authorization requests.
• Provide drug information support and research clinical literature for prior authorization decisions.
• Coordinate and assist in the preparation of utilization and compliance reporting for client plans.
• Provide feedback to Prior Authorization Coordinators regarding processing of PA cases.
• Deliver in-service education to PACs on PA guidelines and common diagnoses.

Benefits

• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• Tuition reimbursement
• Paid time off
• Vision insurance
• 401(k) matching
• Life insurance
• Referral program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Ph.D. or professional degree