MedImpact Healthcare Systems, Inc.
Clinical Specialist
MedImpact Healthcare Systems, Inc., San Diego, California, United States, 92189
### 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.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!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** 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 with projects associated with prior authorization program development, implementation and internal and external communications.* Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists. Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.* Handling Provider, Pharmacy and member calls to complete prior authorization and Peer to Peer requests based on client specific 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. The requirements listed below are representative of the knowledge, skill, and/or ability required. 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**To perform this job successfully, an individual should have 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. Ability to write simple correspondence.
* Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**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**This is a full-time non-exempt position #J-18808-Ljbffr
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.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!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** 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 with projects associated with prior authorization program development, implementation and internal and external communications.* Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review. This includes PAs that do not follow proper protocol of initial reviews before sending to the Clinical Specialists. Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.* Handling Provider, Pharmacy and member calls to complete prior authorization and Peer to Peer requests based on client specific 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. The requirements listed below are representative of the knowledge, skill, and/or ability required. 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**To perform this job successfully, an individual should have 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. Ability to write simple correspondence.
* Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:ComposureDecision QualityOrganizational AgilityProblem SolvingCustomer FocusDrive for ResultsPeer RelationsTime ManagementDealing with AmbiguityLearning on the FlyPolitical Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**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**This is a full-time non-exempt position #J-18808-Ljbffr