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 departmentsEvaluate, 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 determinationsPerform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations that are outside clinical guideline criteriaProvide detailed and thorough documentation in prior authorization cases, appeals cases, and overridesMake clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround timesMaintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirementsProvide mentorship to the Clinical Review Technician team as requiredSupport Medication Therapy Management (MTM) and adherence programsContribute to disease management initiatives and population health strategiesAssist Clinical Account Managers in delivering clinical solutions to clientsRespond to client inquiries regarding clinical programs and benefit designAssist in preparing presentations for client meetings and quarterly business reviewsAssist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist interventionWorks to promote a team environmentSupport the operation and maintenance of existing MedOne Clinical ServicesAssists and supports members of MedOne Pharmacy Benefit SolutionsPortrays the company in a positive imageRequired to abide by all rules, regulations and policies of the employerOther 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 audiencesHigh degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solutionDetail-oriented with a high degree of accuracyStrong interpersonal, written, and verbal communication skillsAbility to work independently and manage time effectivelyExcellent 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 plusMust be able to type at a minimum of 30 words per minuteMust be able to work independently, meets deadlines, establish priorities, and be flexibleMust be able to stand/sit for long periods of time within limited spaceMust be able to lift up to 25 poundsMust be able to work cooperatively with MedOne staff