Clinical Review Pharmacist
full-time•Dubuque
About this role
Description
Position Overview:
MedOne 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.
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:
- 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.
- Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention.
What you will bring to MedOne:
- 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 MedOne! You can submit your application through our careers page.
MedOne 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.
What you'll do
- The pharmacist will evaluate, review, and interpret clinical guideline criteria to render coverage determinations (approvals, denials) and perform outbound clinical consult calls with providers or patients regarding these determinations. They will also perform scientific literature evaluations to support decisions outside of standard guidelines and maintain quality and productivity standards.
About MedOne Pharmacy Benefit Solutions
MedOne unlocks the most appropriate prescription at the most affordable price for organizations and their health plan members nationwide. The MedOne model delivers real prescription savings by cutting out the traditional "PBM" middlemen and facilitating direct relationships between health plans and high-performing pharmacies. Once we establish a transparent and aligned marketplace, we partner with organizations to optimize "where" and "what" members fill to reduce pharmacy costs and improve health outcomes.
Ready for a new approach to pharmacy benefits? We invite you to experience the difference!
Ready to join MedOne Pharmacy Benefit Solutions?
Take the next step in your career journey
Frequently Asked Questions
What does a Clinical Review Pharmacist do at MedOne Pharmacy Benefit Solutions?
As a Clinical Review Pharmacist at MedOne Pharmacy Benefit Solutions, you will: the pharmacist will evaluate, review, and interpret clinical guideline criteria to render coverage determinations (approvals, denials) and perform outbound clinical consult calls with providers or patients regarding these determinations. They will also perform scientific literature evaluations to support decisions outside of standard guidelines and maintain quality and productivity standards..
Is the Clinical Review Pharmacist position at MedOne Pharmacy Benefit Solutions remote?
The Clinical Review Pharmacist position at MedOne Pharmacy Benefit Solutions is based in Dubuque, Iowa, United States. Contact the company through Clera for specific work arrangement details.
How do I apply for the Clinical Review Pharmacist position at MedOne Pharmacy Benefit Solutions?
You can apply for the Clinical Review Pharmacist position at MedOne Pharmacy Benefit Solutionsdirectly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process.