Pharmacy Analyst - ESI (Remote)

Description

WHO WE ARE

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

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



Staff level position responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming pharmacy review requests, preparing review information and materials for assignment to appropriate reviewers, entering pharmacy case review data in the online case summary/tracking system, receiving and reviewing Reviewer decisions, completing outreach over the phone to gather additional information for cases, taking inbound phone calls from medical professionals, issuing appropriate, timely and accurate review outcome notifications and completion of pharmacy case review data in the online case summary/tracking system and client system

Roles:

• To prepare high quality appropriate pharmacy case review information and materials for submission to the reviewers
• To finalize the pharmacy case review process and issue review outcome notifications to appropriate parties of the case
• To serve as a company liaison with clients, reviewers and practitioners/providers/facilities whose services are subject to review

Major Responsibilities or Assigned Duties:

• Screen incoming pharmacy review requests for completeness of materials required to conduct the review of the case
• Prepare, organize, distribute and present records, materials and forms required for a complete pharmacy case review by reviewers
• Identify appropriate reviewers for pharmacy case review assignment including: determine their availability for a review assignment and obtain information for delivery of the case to the Reviewer if applicable
• Contact clients to resolve questions, obtain information, records and/or materials needed for a pharmacy case review and resolve issues about active cases 
• Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
• Complete outreach via fax and over the phone to obtain missing information necessary to issue appropriate clinical decisions
• Receive incoming phone calls from medical professionals checking status on cases and/or providing additional information to decision cases
• Create and maintain an in-house review file for each active pharmacy case
• Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
• Issue oral and written review outcome notifications that comply with standards and requirements for timeliness, content, recipients and accuracy including written notification grammar and spelling as needed
• Research clients’ questions about review processes and/or Reviewer decisions 
• Determine the need for additional information or additional review and notify the client and internal departments of these needs
• Support all Quality Management initiatives
• Actively participate in the compliance process and Provider Relations assessment process
• Support all compliance program activities
• Participate in all company meetings and committees as requested
• Adhere to all policies and procedures
• Take feedback and responsibility for performance
• Adapt to the differences of clients
• Maintain a flexible schedule to meet client needs
• Complete other duties and responsibilities as directed 
• Collaborate with and cross-train on other teams as needed

Requirements

Skills and Experience: 

• Ability to work in a fast-paced and high-functioning environment and meet deadlines while managing multiple high priorities 
• Ability to work independently with minimal supervision
• High level of adaptability, evidenced by the ability to thrive in dynamic environments and rapidly adjust to shifting priorities
• Personal computer literacy and high competency in use of Microsoft Word 
• Strong organizational skills with attention to details
• Strong oral and written communication skills
• Well-developed training skills
• Strong working knowledge of basic anatomy, physiology and medical terminology preferred
• Strong working knowledge of medical insurance terminology and processes preferred
• Strong working knowledge of prescription drug terminology preferred
• Excellent critical thinking capabilities with a strong attention to detail
• Exceptional customer service skills
• Thorough understanding and knowledge of Company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards 
• Minimum of one year pharmacy experience preferred
• Minimum of one year in a similar operation preferred (health insurance, healthcare and/or managed care arena) preferred

Education:

• High school diploma or equivalent

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 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.



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.