Position Overview

The Clinical Specialty Review Pharmacist role provides the unique opportunity to apply clinical expertise and high-level decision-making for complex specialty therapy prior authorization and appeals review (i.e. oncology, autoimmune, rare diseases, bleeding disorders, etc.), with additional opportunities to provide clinical consultation, evidence evaluation, and cross-functional support.

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) with a focus on specialty medications.
• Perform outbound clinical consultation calls with physicians, healthcare providers, and patients, as requested and scheduled, to address questions regarding coverage 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.
• Engage in Pharmacy and Therapeutics Committee discussions/changes; and potential membership.
• Assist Member Advocate and Account Management teams with patient, provider and pharmacy requests requiring pharmacist intervention.
• Works to promote a team environment.
• Close collaboration with account management and clinical leadership.
• 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

• Preferred 2-5+ years of experience in managed care, specialty pharmacy, clinical review, utilization management, or prior authorization operations.
• 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.
• 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 preferred.
• Must be able to type at a minimum of 40-50 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.
• Excellent customer service and teamwork skills.

Why Join MedOne?

• Competitive salary and bonuses that reward your performance.
• Comprehensive health, dental, and vision insurance.
• 401(k) with company match to secure your future.
• Generous paid time off and holidays.
• Opportunities for professional growth and development.
• A vibrant and collaborative work culture.

Location

We have offices in either Dubuque, IA, or Kansas City, KS, or the position can be remote within the United States.

Employment Type

Full-Time, Hourly/Exempt.

Hours

Hours may vary within our normal business hours.

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.