Clinical Specialist

This is a full time opening with full benefits and weekly direct deposit pay. This is a W2 position not 1099 contract.

Description:

The Clinical Specialist manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions.

What You Get To Do:

• Responsible for providing clinical support services to client plan(s) contracting for clinical services

• Support services will include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and appeal requests as required by client contracts and Utilization Management delegation agreements

• Review medication request guidelines for clinical appropriateness and operational efficiency

• Assist in the revision and creation of new or existing medication request guidelines as indicated

• Provide drug information support

• Research and provide clinical literature documentation to support prior authorization decisions as indicated

• May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review

• Coordinate and assist in the preparation of utilization and compliance reporting for client plans

• Ensure timely preparation and review of plan data and client presentations, when required

• Coordinate and assist with projects associated with prior authorization program development, implementation and internal and external communications

• Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review

• Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process

Skills:

Health care, telehealth, communication skills, Pharmacy, Pharmd, Prior authorization, Mtm, Medicare, Retail pharmacy, Medicaid, Insurance verification

Additional Skills & Qualifications:

Education and/or Experience

• For consideration candidates will need a Pharmacy degree (Pharm. D.) or equivalent

• Two (2) to five (5) plus years related experience and/or training; or equivalent combination of education and experience

Computer Skills: To perform this job successfully, an individual should have knowledge of Microsoft Office Suite Word Processing software.

Certificates, Licenses, Registrations: Current, unrestricted Registered Pharmacist license.

Other Skills and Abilities

• Excellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment

• Expertise in clinical application of pharmacy practice

• knowledge of Medicaid is a big plus

• candidates who have 2 years of experience from retail, hospital and long term care are a good fit!

Employee Value Proposition (EVP)

Completely remote work from home position. Does not need to live near the work site, but must have an active license in the state they reside.

Work Environment

Monday - Friday 9am-5pm Guam time. 4pm-12am PST, or 1pm-9pm in Hawaii.

Experience Level:

Intermediate Level

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.