Schedules Physician Clinical Review (PCR) utilization management reviews (including peer to peer telephone discussions and provider outreach discussions) for Magellan Rx Management clients for medical pharmacy/specialty, PBM, MRX Navigate, and Medicare Part D areas of business. Performs follow-up to ensure reviews occur as scheduled and written reports are generated by Physician Clinical Reviewers (PCRs). Analyzes pending completion rate based on PA review due dates. Provides updates to relevant departments to ensure turnaround time compliance with accreditation and regulatory organizations. Documents all steps in the process.
- Schedules Physician Clinical Reviewer (PCR) utilization management reviews (including peer to peer telephone discussions and provider outreach discussions).
- Receives requests from various departments to schedule Physician Clinical Reviewer (PCR) reviews.
- Consults with managers on problem cases and interfaces with Medical Directors, clinical supervisors, account managers and other staff in resolving PA review and scheduling issues.
- Provides overall analysis of PA review cases completion rates.
- Responds to provider and client telephone inquiries regarding status and PA review process.
- Organizes volume of work and work-flow so that performance standards and proper procedures for PA reviews timelines according to client requirements and state and federal regulations are addressed.
- Documents activities in database.
- Tracks number of reviews performed on a daily basis by account, type of review, physician clinical reviewer and outcomes.
- Documents physician scheduling process in respective systems, as well as outcome of review.
- Contacts physician clinical reviewers to determine availability and timing to perform reviews as well as coordinates with providers to determine availability and timing for doctor to doctor discussions.
- Forwards all appropriate clinical information, criteria and forms to physician clinical reviewer (as applicable) to conduct reviews.
- Follows up with physician clinical reviewers for written reports to ensure receipt within the requested turn around time.
- Contributes to department processes by attending department meetings, assisting in developing department goals and scorecards and meeting individual performance standards.
Other Job Requirements
Responsibilities
Experience in customer interactions and detailed review of health related materials.
Strong interpersonal skills and attention to detail.
Strong ability to multi-task, work in a fast paced environment and meet all deadlines.
Ability to organize and complete work but ask questions as needed.
Strong organizational and written and verbal communication skills.
Strong working knowledge of Microsoft Office Product Suite. Willing and capable of learning new software applications quickly.
General Job Information
Title
Physician Scheduling Coordinator
Grade
19
Work Experience - Required
Administrative Support, Customer Service, Healthcare
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Associate
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$37,725
Salary Maximum:
$56,595
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
