Clinical Specialist Pharmacy Compliance - Wyoming
Clinical Specialist Pharmacy Compliance - Wyoming$104,342 - $146,600 - $188,858Pay 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.
MedImpact Healthcare Systems, Inc.
is looking for extraordinary people to join our team!Why join MedImpact? 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 MedImpact, 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! The Scoop:
The Clinical Specialist is responsible for providing clinical support to the Provider Audit Team and assist in improving the identification and reporting of aberrant and potentially fraudulent claims, pharmacies, members and prescribers.
Works within the Provider Audit team to achieve overall departmental and company financial goals.
What You Get To Do:
oPrepares and completes retrospective desktop, and targeted audits, including obtaining claim data for analysis, reviewing dispensing activities for billing errors, reviewing federal/state/local pharmacy laws, documenting audit results, notifying pharmacies, and preparing audit plans, and schedules as appropriateoResponsible for providing clinical support services to department and to client plan(s) contracting for audit servicesoSupport services will include, but not limited to, clinical review, data query recommendations, and audited claims review; particularly those reviews requiring clinical expertise (e.
g.
, compound and specialty claims)oReview audit guidelines and algorithms for clinical appropriateness and operational efficiencyoAssist in the revision and creation of new or existing audit guidelines and algorithms as indicatedoProvide drug information supportoResearch and provide clinical documentation to support reporting and algorithm needs as indicatedoMay include recommendations for audit criteria based on known or suspected drug schemes including diversion, doctor and pharmacy shopping, etc.
oCoordinate and assist in the preparation of utilization and audit reporting for client plans based on fraud, waste and abuse reports and data queriesoEnsure timely preparation and review of claims data and client reports, when requiredoCoordinate and assist with projects to identify, analyze, and report on new fraud schemes that may impact MedImpact clients Supervisory ResponsibilitiesThis job has no supervisory responsibilities.
Education and/or ExperienceFor consideration candidates will need:
oPharmacy degree (Pharm.
D.
) or equivalent o2years related retail experience and/or training or equivalent combination of education and experience Computer SkillsIntermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, Project, and Outlook) required.
Familiarity with relational database systems and SQL software front ends such as Cognos highly desirable.
Intermediate to advanced skill set in MedAccess, and SalesForce preferred.
Strong aptitude to learn and adapt to new programs.
Certificates, Licenses, RegistrationsCurrent, unrestricted Registered Pharmacist license in the State of California or a state of the United States.
Other Skills and AbilitiesExcellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment.
Expertise in clinical application of pharmacy practice.
TravelThis position requires travel of up to 25% of the time with overnight requirements for periods of up to one (1) week at a time.
The Perks:
oMedical / Dental / Vision / Wellness Programs oPaid Time Off / Company Paid Holidays o401K with Company match oLife and Disability Insurance oTuition Reimbursement oEmployee Referral BonusThis position is eligible for Employee Referral Bonus at Level I To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.
medimpact.
com/careersMedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California.
Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market.
MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.
S.
and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans OSHA/ADA:
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily.
The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Disclaimer:
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification.
They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Recommended Skills Algorithms Auditing Billing Business Efficiency Claim Processing Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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.
MedImpact Healthcare Systems, Inc.
is looking for extraordinary people to join our team!Why join MedImpact? 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 MedImpact, 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! The Scoop:
The Clinical Specialist is responsible for providing clinical support to the Provider Audit Team and assist in improving the identification and reporting of aberrant and potentially fraudulent claims, pharmacies, members and prescribers.
Works within the Provider Audit team to achieve overall departmental and company financial goals.
What You Get To Do:
oPrepares and completes retrospective desktop, and targeted audits, including obtaining claim data for analysis, reviewing dispensing activities for billing errors, reviewing federal/state/local pharmacy laws, documenting audit results, notifying pharmacies, and preparing audit plans, and schedules as appropriateoResponsible for providing clinical support services to department and to client plan(s) contracting for audit servicesoSupport services will include, but not limited to, clinical review, data query recommendations, and audited claims review; particularly those reviews requiring clinical expertise (e.
g.
, compound and specialty claims)oReview audit guidelines and algorithms for clinical appropriateness and operational efficiencyoAssist in the revision and creation of new or existing audit guidelines and algorithms as indicatedoProvide drug information supportoResearch and provide clinical documentation to support reporting and algorithm needs as indicatedoMay include recommendations for audit criteria based on known or suspected drug schemes including diversion, doctor and pharmacy shopping, etc.
oCoordinate and assist in the preparation of utilization and audit reporting for client plans based on fraud, waste and abuse reports and data queriesoEnsure timely preparation and review of claims data and client reports, when requiredoCoordinate and assist with projects to identify, analyze, and report on new fraud schemes that may impact MedImpact clients Supervisory ResponsibilitiesThis job has no supervisory responsibilities.
Education and/or ExperienceFor consideration candidates will need:
oPharmacy degree (Pharm.
D.
) or equivalent o2years related retail experience and/or training or equivalent combination of education and experience Computer SkillsIntermediate to advanced skill set in MS Office (Word, Excel, PowerPoint, Project, and Outlook) required.
Familiarity with relational database systems and SQL software front ends such as Cognos highly desirable.
Intermediate to advanced skill set in MedAccess, and SalesForce preferred.
Strong aptitude to learn and adapt to new programs.
Certificates, Licenses, RegistrationsCurrent, unrestricted Registered Pharmacist license in the State of California or a state of the United States.
Other Skills and AbilitiesExcellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment.
Expertise in clinical application of pharmacy practice.
TravelThis position requires travel of up to 25% of the time with overnight requirements for periods of up to one (1) week at a time.
The Perks:
oMedical / Dental / Vision / Wellness Programs oPaid Time Off / Company Paid Holidays o401K with Company match oLife and Disability Insurance oTuition Reimbursement oEmployee Referral BonusThis position is eligible for Employee Referral Bonus at Level I To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.
medimpact.
com/careersMedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego, California.
Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market.
MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.
S.
and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans OSHA/ADA:
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily.
The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Disclaimer:
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification.
They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Recommended Skills Algorithms Auditing Billing Business Efficiency Claim Processing Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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