Clinical Pharmacist

Position Overview:

The Clinical Pharmacist is 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. The Clinical Pharmacist will play a key role in optimizing medication therapy and improving patient outcomes within a Pharmacy Benefit Management (PBM) environment.

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