Clinical Services Specialist

KPH Healthcare Services • Full-time • Remote (East Syracuse, NY) • 1d ago

Overview

Scope of Responsibilities: Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct. Works under direct supervision and follows standard procedures to accomplish assigned tasks.

Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.

Responsibilities

Job Duties:

Oversee the prior authorization process to maintain efficiency and timeliness.
Review prior authorization requests based on currently-available guidelines
Provide Help Desk support, where appropriate, for questions regarding overrides or system edits
Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate
Assist in preparation of member mailings for various cost containment/clinical programs.
Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications
Maintain records of all prior authorizations completed by ProAct
Providing reports on monthly basis
Providing data for Accounting Department for invoicing
Assist in the development and updating of formulary documents
Responsible for completing all mandatory and regulatory training programs
Assist with the day-to-day operations of the ProAct Help Desk
Perform other duties as assigned

Qualifications

Attendance Requirements:

Must be available, and on-time for scheduled work shifts

Educational Requirements:

Minimum: High School Diploma (or currently enrolled) or GED
Preferred: AS Degree or Higher

Required:

National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.

Experience:

Preferred hospital or retail pharmacy experience preferred

Special Conditions of Employment:

Drug test
Initial and continuous exclusion and sanction/disciplinary monitoring
Any and all additional eligibility requirements based on the specific position

Job Skills Required:

Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting
Strong Organizational Skills
Proficient in using Microsoft Excel, Word, and Access
Must be able to work independently

Compensation:

$17.76 - 19.31 an hour

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.

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