Job Description

Description



Who We Are – Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

POSITION OVERVIEW

Our Clinical Review Pharmacist is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities

Role:

• To provide clinical direction, guidance, and support to the management team, staff, and all independent contracting clinician reviewers as indicated

Major Responsibilities or Assigned Duties:

• Perform utilization management case reviews.
• Maintain monthly productivity score per company standard.
• Maintain annual quality score per company standard.
• Train across all queues as requested by MRIoA leadership.
• Complete all client specific training as requested by MRIoA leadership.
• Maintain up-to-date records of case completion.
• Consistently show willingness to take cases as requested.
• Demonstrate respect in interactions across the company.
• Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours.
• Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
• Respond appropriately and in a timely manner to licensing/CME requests from Chief Medical Officer and/or administrative team.
• Actively participate in the MRIoA evaluation process (both company and individual).
• Participate in all company meetings and committees as requested.
• Complete other duties as requested or approved by the CEO and/or Chief Medical Officer

Requirements

Skills and Experience:  

• Minimum of one year of experience working as a pharmacist or PGY 1 preferred
• Experience working with commercial appeals preferred
• Experience working for a health plan or pharmacy benefits manager preferred
• Credentialed and privileged by the company’s credentialing committee
• Thorough understanding of the company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standard
• Willingness to obtain additional state licensure as required for the position

Education:

• PharmD degree
• Pharmacist license in good standing

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info : MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected]. 

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