Prior Authorization Guidelines Specialist

Exemption Status:

United States of America (Non-Exempt)

$22.99 - $30.35 - $37.71

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

Med Impact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join Med Impact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At Med Impact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry.

We are the premier Pharmacy Benefits Management solution!

Summary

Provide technical and administrative support to the Fee-For-Service (FFS) Medicaid department, primarily by working directly with the client teams, Clinical Program Managers (CPMs), Clinical Specialists, and Clinical PA Guidelines/Drug Information Management staff to create and support the appropriate administration of pharmacy information to include Medication Request Guidelines, Medication Request Forms (MRFs), and electronic rules. Support PA in researching PA-related tasks, PA Implementation and perform Prior Authorization processing as needed.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Create and maintain PA Guidelines documents (content management, file maintenance and archiving, coding and linking in on-line electronic systems).
• Provide technical and administrative support to the Clinical Program Manager, Clinical PA Guidelines, Drug Information and PA&UM staffs with the Medication Request process to include formatting, verifying and testing of client Medication Request Guidelines (custom and standard) and formatting/development of Medication Request Forms (MRFs) and electronic rules.
• Communicate with clients to obtain client authorization of final documents and ensure timely distribution of documentation to appropriate departments.
• Direct the timely and accurate communication of information to appropriate department staff to include:
  Medical Exception/Prior Authorization;
  Medication Request Forms (MRFs);
  Clinical Document Maintenance, electronic prior authorization and formulary management rules, and associated tools and programs.
• Manage review/QA process for medical exception/prior authorization guidelines prior to implementation and distribution to clients or internal users.
• Serve as subject matter expert on processes related to the procedures necessary to ensure effective maintenance of Med Impact Prior Authorization program, and as a resource for PA guidelines related questions and/or inquiries from both internal and external customers

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations;
Respo…