Clinical Pharmacist

Med One is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, Med One helps people conveniently access the most appropriate prescriptions at the most affordable price.

• Support operations of Med One Clinical Services Business Unit with responsibilities supporting the clinical review, clinical programs, and clinical account management departments
• Evaluate, review and interpret clinical guideline criteria and appropriately utilize clinical knowledge and resources when rendering coverage determinations (approvals, part approvals, denials)
• Perform and completes outbound clinical consult calls with physicians, healthcare providers and/or patients to as requested to answer inquiries regarding determinations
• Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations that are outside clinical guideline criteria
• Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times
• Maintain quality and productivity standards for all cases reviewed while meeting established turnaround time requirements
• Provide mentorship to the Clinical Review Technician team as required
• Support Medication Therapy Management (MTM) and adherence programs
• Contribute to disease management initiatives and population health strategies
• Assist Clinical Account Managers in delivering clinical solutions to clients
• Respond to client inquiries regarding clinical programs and benefit design
• Assist in preparing presentations for client meetings and quarterly business reviews
• Assist Member Advocate and Account Management teams with patient or provider requests requiring pharmacist intervention
• Works to promote a team environment
• Support the operation and maintenance of existing Med One Clinical Services
• Assists and supports members of Med One Pharmacy Benefit Solutions
• Portrays the company in a positive image
• Required to abide by all rules, regulations and policies of the employer
• Other duties as assigned

• Proficient in Microsoft Office Suite and experience using clinical resources (Micromedex, Lexicomp, Clinical Pharmacology)
• Ability to translate clinical information into a manner appropriate for both clinical and non-clinical audiences
• High degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution
• Detail-oriented with a high degree of accuracy
• Strong interpersonal, written, and verbal communication skills
• Ability to work independently and manage time effectively
• Excellent customer service and teamwork skills
• Must have a designated workplace (an office, spare bedroom, etc.) that is visibly secure from others during work hours (closed door) and is protected from noise that could disrupt conversations (for remote employees)
• Familiarity with data entry software or CRM systems (Microsoft Dynamics) is a plus
• 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 Med One staff