Clinical Review CoordinatorMedOne Pharmacy Benefit Solutions, Dubuque, IA
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MedOne is a national, full-service transparent pharmacy benefit administrator headquartered in Dubuque, Iowa and licensed as a third-party administrator (TPA) by the State of Iowa.
We are an innovative and fast-paced company looking for employees interested in working for a business where they can make a difference. MedOne is committed to building solutions with the most current technologies available in the market place. We operate in a fast-growing industry that supports significant business growth and as a result, wonderful growth opportunities for our employees.
We are looking to hire a Clinical Review Coordinator with excellent organizational and administrative skills. The Clinical Review Coordinator is expected to be a decisive leader with superb time management and record keeping skills. To ensure success, the Clinical Review Coordinator should be confident and professional with fantastic communication and IT skills that will contribute to the efficient day-to-day activities of MedOne Clinical Services. Top candidates will work comfortably under pressure while multi-tasking in a fast-paced environment.
- Support operations of MedOne Clinical Services.
- Support in the administration and management of MedOne clinical programs.
- Evaluate program performance and prepare required reports.
- Contribute to the creation of innovative clinical programs.
- Initiate Prior Authorization requests.
- Review incoming Prior Authorization documentation for completeness.
- Prepare clinical review documentation for review by a MedOne Clinical Pharmacist.
- Communicate clinical review decision to pharmacies and providers.
- File completed Prior Authorization documentation.
- Enter Clinical Review determination into the claims processing system(s).
- Communicate the status of Clinical Reviews with patients.
- Schedule Clinical Review Denial Calls with a Clinical Pharmacist.
- Update Clinical Authorization Criteria and Clinical Review Request Forms under the direction of a Clinical Pharmacist.
- Assists and supports members of MedOne Pharmacy Benefit Solutions.
- Assists and supports members of MedOne Pharmacy Services as needed.
- Must be registered with the state/Iowa Board of Pharmacy as a Pharmacy Technician/Trainee within 30 days of accepting employment.
- Employee must be in good standing with the state board.
- Working knowledge of medical terminology, HIPAA regulations, ICD-10, NCPDC standards (highly advantageous).
- Innovative thinker with strong conceptual and problem-solving skills.
- Meticulous attention to detail with the ability to multi-task.
- Strong organizational, administrative and planning skills.
- Ability to work independently and as part of a team.
- Excellent documentation, communication and IT skills.
- Passionate about clinical excellence.