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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.Job Posting TitleMgr, Clinical Pharmacist Review- REMOTEJob Description SummaryThis position oversees all aspects of the Initial Clinical Review (ICR) process and is responsible for ensuring standardization of operations and compliance with Utilization Review (UR) and Quality Management (QM) requirements, maintaining client service level obligations and quality performance standards.Job Description
Coordinates new hire Individual Case Review (ICR) training programs on use of the pre-authorization system, clinical review guidelines, policy and procedures and fundamental Utilization Review/Quality Management principles.
Coordinates continuing clinical education needs of ICRs and oversee on-going training.
Assures that all services are approved when they meet clinical review criteria and that all cases not meeting approval criteria are referred to peer clinical review.
Oversees random monitoring of ICR calls to determine adherence to review process workflows and delivery of optimum customer service.
Oversees monitoring of ICR documentation to determine that all communication with ordering physicians and their staff are recorded in a timely and accurate manner.
Performs inter-rater reliability tests among ICRs to ensure quality performance in compliance with applicable standards and regulations.
Promotes and maintains ICR compliance with principles of utilization management as delineated in Magellan Policies and Procedures.
Adjusts staff assignments and schedules as needed and oversee schedule requests to ensure ICR group compliance with call center service level obligations.
Participates in system enhancements/revisions and coordination of changes with Informa services.
Communicates updates and changes; keep clinical review staff informed of procedural and system changes through ongoing staff meetings for optimal efficiency.
Reviews annual employee performance evaluations and participate in delivery of the evaluations as needed.
Assures that optimum customer service is provided through professional/accurate communication while maintaining National Committee for Quality Assurance, UtilizationReviewAccreditationCommission and health plan's required timeframes.
Demonstrates support for Magellan's mission and philosophy and keep Director informed of operational and staff issues.
Participates in guideline revisions and updates in coordination with appropriate leadership.
Coordinates with other departments for optimal process efficiency.
Supports and maintain ICR compliance with principles of HIPAA.
Participates in on-site health plan visits.
Responsibilities
Knowledge of healthcare industry required along with Utilization Management (UM) experience.
Exceptional communication and interpersonal skills, including presentation skills.
Excellent organizational skills.
Supervisory experience required.
Strong working knowledge of MS Office Suite and ability to quickly learn new software applications.
5-8 years' clinical experience and a minimum of 3 years' supervisory experience.
Work ExperienceWork Experience - Required:Pharmacy, SupervisoryWork Experience - Preferred:EducationEducation - Required:Bachelors - PharmacyEducation - Preferred:PharmD - PharmacyCertificationsCertifications - Required:RPH - Registered Pharmacist - Pharmacy - PharmacyCertifications - Preferred:PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy - PharmacyPotential pay for this position ranges from $120,220.00 - $204,360.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.
