Clinical Services Specialist

Overview:

Scope of Responsibilities:  Assist with the day-to-day operations of the Clinical Pharmacist and clinical department of ProAct.  Works under direct supervision and follows standard procedures to accomplish assigned tasks.

 

Job Summary: Responsibility for overseeing the prior authorization process, initial prior authorization review, and assisting with tasks and goals that meet the clinical needs of ProAct clients and members.

Responsibilities:

Job Duties:

• Oversee the prior authorization process to maintain efficiency and timeliness.
• Review prior authorization requests based on currently-available guidelines
• Provide Help Desk support, where appropriate, for questions regarding overrides or system edits
• Responsible for working with Implementation Department for loading prior authorization data for new clients when appropriate
• Assist in preparation of member mailings for various cost containment/clinical programs.
• Assist both members and Noble Health Services in finding most cost-effective channels for specialty medications
• Maintain records of all prior authorizations completed by ProAct
• Providing reports on monthly basis
• Providing data for Accounting Department for invoicing
• Assist in the development and updating of formulary documents
• Responsible for completing all mandatory and regulatory training programs
• Assist with the day-to-day operations of the ProAct Help Desk
• Perform other duties as assigned

Qualifications:

Attendance Requirements:

• Must be available, and on-time for scheduled work shifts

 

Educational Requirements:

• Minimum: High School Diploma (or currently enrolled) or GED
• Preferred: AS Degree or Higher

Required:

• National Pharmacy Technician Certification through PTCB, or other accrediting agency, in good standing.

Experience: 

• Preferred hospital or retail pharmacy experience preferred

Special Conditions of Employment:

• Drug test
• Initial and continuous exclusion and sanction/disciplinary monitoring
• Any and all additional eligibility requirements based on the specific position

Job Skills Required:

• Strong Communication Skills: Must be able to effectively communicate both on the phone and in group setting
• Strong Organizational Skills
• Proficient in using Microsoft Excel, Word, and Access
• Must be able to work independently

Compensation:

$17.76 - 19.31 an hour

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education. 

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.