Clinical Review Pharmacist

Overview

Med One is seeking a clinically skilled, detail-oriented pharmacist to support prior authorization reviews, consult with providers, evaluate drug literature, and collaborate across teams to ensure high-quality, guideline-based coverage determinations.

• Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering coverage determinations (approvals, part approvals, denials)
• Perform and complete outbound clinical consult calls with physicians, healthcare providers and/or patients to answer inquiries regarding determinations
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations that are outside clinical guideline criteria
• Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements
• Provide mentorship to the Clinical Review Technician team as required
• Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention

• Pharmacy degree from an accredited school of pharmacy
• Registered Pharmacist with a state license in good standing
• PGY1 Managed Care Residency (preferred)
• Proficient in Microsoft Office Suite and experience using clinical resources (Micromedex, Lexicomp, Clinical Pharmacology)
• Ability to translate clinical information into a manner appropriate for both clinical and non-clinical audiences
• High degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
• Detail-oriented with a high degree of accuracy
• Strong interpersonal, written, and verbal communication skills
• Ability to work independently and manage time effectively
• Excellent customer service and teamwork skills
• Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) due to PHI and is protected from noise that could disrupt conversations
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus

Location:

We have offices in either Dubuque, IA, or Kansas City, MO, or the position can be remote within the United States.

Employment Type:

Full-Time, Salary/Exempt

How to Apply:

If you re enthusiastic about helping others and eager to join a dynamic team, we’d love to hear from you. Apply now and take the first step toward a rewarding career at Med One! You can submit your application through our careers page.

Med One is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Job Offers are contingent on passing a background check and drug screen.