Job Description

Description:

The Scoop:

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.

What You Get To Do:

• Responsible for providing clinical support services to client plan(s) contracting for clinical services

• Support services will include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and appeal 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

• Provide drug information support

• Research and provide clinical literature documentation to support prior authorization decisions as indicated

• May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review

• Coordinate and assist in the preparation of utilization and compliance reporting for client plans

• Ensure timely preparation and review of plan data and client presentations, when required

• 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

• Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process

Skills:

Health care, Kentucky Pharmacist license, telehealth, communication skills, arizona pharmacist license, california pharmacist license, Pharmacy, Pharmd, Prior authorization, Mtm, Medicare, Retail pharmacy, Medicaid

Top Skills Details:

Health care,Kentucky Pharmacist license,telehealth,communication skills,arizona pharmacist license,california pharmacist license,Pharmacy,Pharmd,Prior authorization

Additional Skills & Qualifications:

Education and/or Experience

• For consideration candidates will need a Pharmacy degree (Pharm. D.) or equivalent

• Two (2) to five (5) plus years related experience and/or training; or equivalent combination of education and experience

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 the State of Kentucky.

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

-Knowledge of Medicaid is a big plus

-Candidates who have 2 years of experience from retail, hospital and long term care are a good fit!

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We\'re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

Actalent