Clinical Services Specialist
Overview:
Scope of Responsibilities: Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks.
Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.
Responsibilities:Job Duties
- Oversee the prior authorization process to maintain efficiency and timeliness.
- Review prior authorization requests based on currently-available guidelines
- Provide Help Desk support, where appropriate, for questions regarding overrides or system edits
- Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate
- Assist in preparation of member mailings for various cost containment/clinical programs.
- Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications
- Maintain records of all prior authorizations completed by ProAct
- Providing reports on monthly basis
- Providing data for Accounting Department for invoicing
- Assist in the development and updating of formulary documents
- Responsible for completing all mandatory and regulatory training programs
- Assist with the day-to-day operations of the ProAct Help Desk
- Perform other duties as assigned
Attendance Requirements
- Must be available, and on-time for scheduled work shifts
Educational Requirements
- Minimum: High School Diploma (or currently enrolled) or GED
- Preferred: AS Degree or Higher
Required:
- National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.
Experience
- Preferred hospital or retail pharmacy experience preferred
Special Conditions of Employment
- Drug test
- Initial and continuous exclusion and sanction/disciplinary monitoring
- Any and all additional eligibility requirements based on the specific position
Job Skills Required
- Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting
- Strong Organizational Skills
- Proficient in using Microsoft Excel, Word, and Access
- Must be able to work independently
Compensation
$17.76 - 19.31 an hour
The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.
KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
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