Clinical Pharmacist

About MedOne: MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price. What You Will Do at MedOne: Support operations of MedOne Clinical Services Business Unit with responsibilities supporting the clinical review, clinical programs, and clinical account management departments Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering coverage determinations (approvals, part approvals, denials) Perform and completes outbound clinical consult calls with physicians, healthcare providers and/or patients to as requested 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 Support Medication Therapy Management (MTM) and adherence programs Contribute to disease management initiatives and population health strategies Assist Clinical Account Managers in delivering clinical solutions to clients Respond to client inquiries regarding clinical programs and benefit design Assist in preparing presentations for client meetings and quarterly business reviews Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention Works to promote a team environment Support the operation and maintenance of existing MedOne Clinical Services Assists and supports members of MedOne Pharmacy Benefit Solutions Portrays the company in a positive image Required to abide by all rules, regulations and policies of the employer Other duties as assigned What you will bring to MedOne: 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) and is protected from noise that could disrupt conversations (for remote employees) Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus Must be able to type at a minimum of 30 words per minute Must be able to work independently, meets deadlines, establish priorities, and be flexible Must be able to stand/sit for long periods of time within limited space Must be able to lift up to 25 pounds Must be able to work cooperatively with MedOne staff #J-18808-Ljbffr