MedImpact Healthcare Systems, Inc.
Clinical Specialist
MedImpact Healthcare Systems, Inc., San Diego, California, United States, 92189
Job Title
Join to apply for the
Clinical Specialist
role at
MedImpact Healthcare Systems, Inc.
Job Posting 3 days ago Be among the first 25 applicants
Exemption Status United States of America (Non-Exempt)
$52.17 - $73.30 - $94.43
Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.
This position is not eligible for Sponsorship.
About the Company 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!
Job Description 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
Responsible for providing clinical review support services to client plan(s) contracting for clinical services, including reviewing prior authorization requests and deciding to approve or deny the request.
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.
Provide drug information support and research clinical literature documentation to support prior authorization decisions.
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 PA case processing and provide in-service education to PACs on PA guidelines and common diagnoses.
Handle provider, pharmacy and member calls to complete prior authorization and peer-to-peer requests as per client requirements.
Assist with training to support growth of the Prior Authorization Department.
Supervisory Responsibilities 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.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas.
Computer Skills Knowledge of Microsoft Office Suite Word Processing software.
Certificates, Licenses, Registrations Current, unrestricted Registered Pharmacist license in any state of the United States.
Other Skills and Abilities
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.
Reasoning Ability
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.
Mathematical Skills
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.
Language Skills
Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Competencies
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
Physical Demands Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Employee is regularly required to sit, talk, hear, stand, walk, use hands to finger, handle, or feel, and lift up to 25 pounds.
Work Environment May be exposed to moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. Noise level usually moderate.
Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.
Working Hours The position requires full-time hours, may require overtime, nights, weekends, or holidays. Typical hours Monday through Friday 8:00 am to 5:00 pm.
Travel Requires no travel; attendance may be required at local conferences and meetings.
Perks
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately‑held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high‑value solutions to payers, providers, and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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Clinical Specialist
role at
MedImpact Healthcare Systems, Inc.
Job Posting 3 days ago Be among the first 25 applicants
Exemption Status United States of America (Non-Exempt)
$52.17 - $73.30 - $94.43
Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.
This position is not eligible for Sponsorship.
About the Company 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!
Job Description 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
Responsible for providing clinical review support services to client plan(s) contracting for clinical services, including reviewing prior authorization requests and deciding to approve or deny the request.
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.
Provide drug information support and research clinical literature documentation to support prior authorization decisions.
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 PA case processing and provide in-service education to PACs on PA guidelines and common diagnoses.
Handle provider, pharmacy and member calls to complete prior authorization and peer-to-peer requests as per client requirements.
Assist with training to support growth of the Prior Authorization Department.
Supervisory Responsibilities 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.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas.
Computer Skills Knowledge of Microsoft Office Suite Word Processing software.
Certificates, Licenses, Registrations Current, unrestricted Registered Pharmacist license in any state of the United States.
Other Skills and Abilities
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.
Reasoning Ability
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.
Mathematical Skills
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.
Language Skills
Ability to read and comprehend simple instructions, short correspondence, and memos; write simple correspondence.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Competencies
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
Physical Demands Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Employee is regularly required to sit, talk, hear, stand, walk, use hands to finger, handle, or feel, and lift up to 25 pounds.
Work Environment May be exposed to moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. Noise level usually moderate.
Work Location This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.
Working Hours The position requires full-time hours, may require overtime, nights, weekends, or holidays. Typical hours Monday through Friday 8:00 am to 5:00 pm.
Travel Requires no travel; attendance may be required at local conferences and meetings.
Perks
Medical / Dental / Vision / Wellness Programs
Paid Time Off / Company Paid Holidays
Incentive Compensation
401K with Company match
Life and Disability Insurance
Tuition Reimbursement
Employee Referral Bonus
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately‑held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high‑value solutions to payers, providers, and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
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