Clinical Specialty Review Pharmacist

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 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 requirementsEngage in Pharmacy and Therapeutics Committee discussions/changes; and potential membershipAssist Member Advocate and Account Management teams with patient, provider and pharmacy requests requiring pharmacist interventionWorks to promote a team environmentClose collaboration with account management and clinical leadershipAssists 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:Preferred 2-5+ years of experience in managed care, specialty pharmacy, clinical review, utilization management, or prior authorization operationsProficient 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 effectivelyMust 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 preferredMust be able to type at a minimum of 40-50 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 staffExcellent customer service and teamwork skills Why Join MedOne?Competitive salary and bonuses that reward your performanceComprehensive health, dental, and vision insurance401(k) with company match to secure your futureGenerous paid time off and holidaysOpportunities for professional growth and developmentA vibrant and collaborative work culture