JOB POSTING IS EXPIRED
Clinical Review Technician I

Job Overview

Company & Position Overview

The Clinical Review Technician works under the supervision of the licensed pharmacist on duty during day-to-day operations and reports directly to the Director of Clinical Review. The Clinical Review Technician will perform clinical functions in supporting the daily operations of MedOne Clinical Services. MedOne will assign each workforce member a level of access based on the individual’s need for electronic patient’s protected health information (ePHI) to perform their job functions. The ideal candidate will be a self-starter, who is detail-oriented and accurate in their day-to-day work. This candidate should be culture-focused, bringing enthusiasm to the office and offering up new ideas and programs. This candidate should also have experience with a variety of office software (email tools, spreadsheets, and word processors).

Essential Job Functions

• Support operations of MedOne Clinical Services
• Conduct clinical assessments to evaluate the appropriateness of medication therapy as part of the clinical review/prior authorization process.
• Communicate clinical review decision to pharmacies and providers
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements
• Provide mentorship to the Data Entry Specialist team as required
• Assist Member Advocate and Account Management teams with patient or provider requests not requiring pharmacist intervention
• Works to promote a team environment
• Support the operation and maintenance of existing MedOne Clinical Services
• Assists and supports members of MedOne Pharmacy Benefit Solutions
• Portrays the company in a positive image
• Required to abide by all rules, regulations and policies of the employer
• Other duties as assigned

Work Hours

• Full time (greater than 30 hours per week), non-exempt

Required Experience & Skills

• Familiarity with PAHub processes; with 6-12 months of relevant DES experience within the last 12 months preferred
• Detail-oriented with a high degree of accuracy
• Strong interpersonal, written, and verbal communication skills
• Ability to work independently and manage time effectively
• Excellent customer service and teamwork skills
• Must 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)
• Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint)
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus.
• Must be able to type at a minimum of 30 words per minute
• Must be able to work independently, meets deadlines, establish priorities, and be flexible
• Must be able to stand/sit for long periods of time within limited space
• Must be able to lift up to 25 pounds
• Must be able to work cooperatively with MedOne staff

Required licenses or certifications

• Iowa Board of Pharmacy as a Pharmacy Technician/Trainee within 30 days of accepting employment (applicable to in-office personnel)
• CPhT certification, or state equivalent, within 90 days of employment