Clinical Pharmacy Coordinator (Remote)

Position Overview

The Clinical Pharmacy Coordinator is responsible for carrying out day-to-day departmental tasks, including screening incoming pharmacy review requests, preparing review information and materials for assignment to reviewers, entering pharmacy case review data, and issuing review outcome notifications.

Roles

• To prepare high quality appropriate pharmacy case review information and materials for submission to the reviewers
• To finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
• To serve as a company liaison with clients, reviewers, and practitioners/providers/facilities whose services are subject to review

Major Responsibilities or Assigned Duties

• Screens incoming pharmacy review requests for completeness of materials required to conduct the review of the case
• Prepares, organizes, distributes and presents records, materials and forms required for a complete pharmacy case review by reviewers
• Identifies appropriate reviewers for pharmacy case review assignment including: determine their availability for a review assignment and obtain information for delivery of the case to the Reviewer if applicable
• Contact clients to resolve questions, obtain information, records and/or materials needed for a pharmacy case review and resolve issues about active cases
• Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
• Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
• Create and maintain an in-house review file for each active pharmacy case
• Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling as needed
• Research clients’ questions about review processes and/or Reviewer decisions
• Determine the need for additional information or additional review and notify the client and internal departments of these needs
• Support all Quality Management initiatives
• Actively participate in the compliance process and Provider Relations assessment process
• Support all compliance program activities
• Participate in all company meetings and committees as requested
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Adapt to the differences of clients
• Complete other duties and responsibilities as directed
• Collaborate with and cross-train on other teams as needed

Requirements

• Minimum of one year pharmacy experience preferred
• Minimum of one year in a similar operation preferred (health insurance, healthcare and/or managed care arena) preferred
• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities
• Ability to work independently with minimal supervision
• High level of adaptability, evidenced by the ability to thrive in dynamic environments and rapidly adjust to shifting priorities
• Personal computer literacy and high competency in use of Microsoft Word
• Strong organizational skills with attention to details
• Strong oral and written communication skills
• Well-developed training skills
• Strong working knowledge of basic anatomy, physiology and medical terminology preferred
• Strong working knowledge of medical insurance terminology and processes preferred
• Strong working knowledge of prescription drug terminology preferred
• Excellent critical thinking capabilities with a strong attention to detail
• Exceptional customer service skills
• Thorough understanding and knowledge of Company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards