Clinical Pharmacy Technician

🕒 2 days ago

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

🛡️ Insurance

💼 Consulting

⚖️ Legal

Insurance • Consulting • Legal

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• Process prior authorization requests in accordance with standards for accuracy, timeliness, productivity, and client performance commitments. • Perform analysis, obtain information, and enter prior authorization data necessary for claims adjudication. • Utilize reasoning skills to identify missing information and make prior authorization processing determinations based on clinical protocols and client guidelines. • Interact with internal and external customers to provide and obtain information and ensure the delivery of outstanding service and quality. • Enter prior authorizations into the system and prioritize requests. • Check formulary alternatives and review tried and failed medications. • Utilize drug references and verify the drug being requested is indicated and approved for the condition. • Document all related information regarding the PA approval or non-approval. • Analyze, research, and resolve prior authorization processing issues. • Coordinate within the client system outbound communication to members, physicians, and pharmacies as required to obtain missing information and manage pending requests. • Protect and maintain confidentiality and privacy of all prior authorization and member information, including following strict protocols.

🎯 Requirements

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities. • Moderate-to-high level of medication and disease state knowledge within the scope of pharmacy practice • Personal computer literacy and high competency in using Microsoft Word, Excel, Adobe, etc. • Strong organizational skills with attention to detail • Strong oral and written communication skills • Excellent critical thinking capabilities with a strong attention to detail • Exceptional customer service skills • Minimum one-year prior authorization experience preferred • Health plan or Pharmacy Benefit Manager experience preferred

🏖️ Benefits

• healthcare, vision, and dental insurance • A generous 401(k) match • Paid vacation, PTO, and holidays • Growth and training opportunities • An award-winning remote work environment