[Hiring] Clinical Pharmacy Coordinator @MRIoA

Role Description

Our Clinical Pharmacy Coordinator is responsible for carrying out day-to-day departmental tasks and completing all processes for:

• Screening incoming pharmacy review requests
• Preparing review information and materials for assignment to appropriate reviewers
• Entering pharmacy case review data in the online case summary/tracking system
• Receiving and reviewing Reviewer decisions
• Completing outreach over the phone to gather additional information for cases
• Taking inbound phone calls from medical professionals
• Issuing appropriate, timely, and accurate review outcome notifications
• Completing pharmacy case review data in the online case summary/tracking system and client system

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:

• Screen incoming pharmacy review requests for completeness of materials required to conduct the review of the case
• Prepare, organize, distribute, and present records, materials, and forms required for a complete pharmacy case review by reviewers
• Identify appropriate reviewers for pharmacy case review assignment
• Contact clients to resolve questions and obtain information, records, and/or materials needed for a pharmacy case review
• Respond to reviewers’ requests for additional information/materials necessary for a review
• Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
• Receive incoming phone calls from medical professionals checking status on cases and/or providing additional information to decision cases
• 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
• 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
• Maintain a flexible schedule to meet client needs
• Complete other duties and responsibilities as directed
• Collaborate with and cross-train on other teams as needed

Qualifications

• Minimum of one year pharmacy experience preferred
• Minimum of one year in a similar operation preferred (health insurance, healthcare and/or managed care arena)
• 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

Education

• High school diploma or equivalent

Work Environment

• Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required
• This role is designed to be a remote position (work-from-home)

Diversity Statement

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Drug-Free Workplace

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only)

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected].