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22Mar

Clinical Review Coordinator

Medone Healthcare Systems, Dubuque, IA

MedOne Healthcare Systems 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.

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 databases).

Essential Job Functions

  • Support operations of MedOne Clinical Services
  • 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
  • Work well in a team environment
  • Supports operations of MedOne Pharmacy Services as needed
  • Assists and supports members of MedOne Healthcare Systems
  • Portrays the company in a positive image
  • Required to abide by all rules, regulations and policies of the employer

Work Hours         

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

Required Experience & Skills

  • Must be detail-oriented and precise
  • Must have excellent interpersonal, written, and verbal skills
  • Strong customer service and teamwork skills
  • Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint)
  • 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 Healthcare Systems staff

NOTE:  This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the organization.

Equal Opportunity Employer (EOE)

 

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Job Details

Req Num --
ID 499071
Location
Dubuque, IA
Positions 1
Type
Employee
Status
Full Time
Pay --
Categories
Clerical/Office Administration
Customer Service
Health Care
Pharmacy
Technical
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Paid Vacation
Paid Holidays

Preferred Candidates

Years of Experience --
Education --

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