Qureos Mentor

Empirx Health

<div>Per Diem Pharmacist 
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically&trade;, EmpiRx Health&rsquo;s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.
Who We're Looking For:
In this critical role, the Per Diem Pharmacist ensures clinical prior authorization and appeal determinations are completed in accordance with covered plan design while delivering clinically appropriate pharmacy care and driving sustainable clinical savings for clients. The pharmacist supports EmpiRx Health&rsquo;s Population Health Management model through collaboration, evidence-based decision-making, and proactive engagement with providers.
What You'll Do:
Key Responsibilities:
Clinical Review &amp; Determinations<div><ul><li>
Act as a clinical expert on prior authorization review and evaluation in accordance with clinical criteria and covered plan design.</li><li>
Review, evaluate, and resolve all assigned clinical reviews through comprehensive case review and direct physician engagement aligned withEmpiRxHealth&rsquo;s Population Health Management model.</li><li>
Perform peer-to-peer reviews with providers as needed or when requested.</li><li>
Convey clinical determinations promptly within established turnaround time requirements to prescribers, members, and healthcare professionals following established approval and denial protocols.</li></ul></div>
Clinical Oversight &amp; Quality Assurance<div><ul><li>
Monitor and proactively identify clinical interventions to ensure clinical savings guarantees are met.</li><li>
Review and evaluate current clinical literature to support recommendations and decision-making.</li><li>
Participate in continuous quality improvement initiatives to streamline clinical review processes and enhance member care.</li><li>
Stay informed onEmpiRxHealth formulary updates, clinical programs, and internal policies.</li></ul></div>
Collaboration &amp; Communication<div><ul><li>
Provide guidance and support to members, providers, and other healthcare professionals regarding clinical inquiries.</li><li>
Collaborate with clinical technicians and prior authorization team members to facilitate clinical review requests, resolve escalations, and answer inquiries.</li><li>
Act as a clinical resource for internal staff, supporting staff training and development as needed.</li></ul></div>
Technology &amp; Documentation<div><ul><li>
Proficiently utilize pharmacy management software for case documentation and communications.</li><li>
Proficiently utilize Microsoft Office tools to support analysis and reporting.</li><li>
Utilize external clinical and drug information resources (e.g., IPD, Policy Reporter, UpToDate,MediSpan) to support reviews, decisions, and awareness of emerging drugs.</li></ul></div>
Collaborate cross-functionally with internal clinical teams for claim/data review, clinical interventions, and provider/member/client support as required
What You Need:
Education<div><ul><li>
Pharm.D. degree from an accredited college of pharmacy (Required).</li></ul></div>
Experience<div><ul><li>
Minimum of 3 years of pharmacy experience in clinical, PBM, or managed care settings.</li><li>
Prior experience with prior authorization, utilization management, or health plan operations preferred.</li></ul></div>
Licensure/Certifications<div><ul><li>
Active Pharmacist License in good standing (Required).</li></ul></div>
Skills &amp; Competencies<div><ul><li>
Strong clinical judgment and analytical thinking skills.</li><li>
Exceptional written and verbal communication.</li><li>
High attention to detail and accuracy in documentation.</li><li>
Excellent organizational and multitasking abilities.</li><li>
Proficient in Microsoft Office Suite and pharmacy systems.</li><li>
Ability to work independently and collaboratively in a fast-paced environment.</li></ul></div> 
Work Environment: Remote
Benefits And Perks
Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental &amp; Vision coverage, Health Savings Account, and an Employee Assistance Program
EmpiRx Health is an Equal Opportunity Employer
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together
Note: This job description is a general outline of responsibilities and qualifications for the role. Additional duties may be assigned, and the position may evolve to meet the organization's needs.</div>

Per Diem Pharmacist

<div>Clinical Operations Specialist 
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results. 
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically&trade;, EmpiRx Health&rsquo;s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years. 
The Clinical Operations (Clin Ops) team is accountable for proficiency with the adjudication platform, understanding claim processing, and clinical review support. Clin Ops staff must operate effectively for client/members overrides and clinical reviews in a timely manner to ensure members are receiving white glove service. ClinOps will closely and collaboratively work with call center, clinical pharmacists, and other internal EmpiRx Health teams. 
If you are a highly motivated Clinical Operations Specialist with robust administrative support experience related to pharmacy adjudication processes and clinical review procedures and are eager to make a meaningful impact in the healthcare industry, we encourage you to apply. 
Key Responsibilities:<ul><li>
Deliver white-glove service excellence by making sure caseload is handled in a timely manner</li><li>
Serve as an account support to clinical pharmacist for adjudication related matters (e.g., clinical overrides)</li><li>
Serve as an account support to call center for adjudication related matters (e.g., non-clinical overrides)and clinical review related matters (e.g., clinical review requests by prescriber, pharmacy, or member)</li><li>
Serve as an account support to Client Management for related overrides needed (e.g., ancillary bypass, vacation bypass, etc.)</li><li>
Serve as an account support to other Care Management teams (MCA, CPT, CARS, CAE) for related overrides needed (e.g., DUR, high cost, clinical review approval overrides, etc.)</li><li>
Ensure daily process/protocols are being followed for daily management</li><li>
Ensure day-to-day clinical review processes are supporting (e.g., PA intake, documentation, and communication oversight)</li><li>
Ensure escalation requests are handled in a timely manner, following defined practices and within targeted 2-hour turnaround time</li><li>
Complete assigned worklists in timely manner to meet our KPI standards</li><li>
Perform under the supervision of ClinOps Manager and clinical pharmacists</li><li>
Utilize internal tools and reporting to effectively perform job duties (e.g. Tredium, JMT)</li><li>
Serve as experts on adjudication system (e.g., claims processing, clinical review support)</li><li>
Collaboratively work with other internal EmpiRx Health teams for needed support (e.g., Client Management and Call Center)</li></ul>
Required Qualifications &amp; Experience:<ul><li>
Minimum 5 years of pharmacy experience</li><li>
Certified Pharmacy Technician</li><li>
Strong customer service orientation and commitment to delivering concierge-level service</li><li>
Ability to work in a fast-paced environment</li><li>
Time management skills with ability to meet tight deadlines</li><li>
Excellent verbal and written communication skills</li><li>
Proficient in Microsoft Office Suite</li></ul>
Preferred Qualifications: (not needed if internal)<ul><li>
College Degree Preferred</li></ul>
 SHIFT IS M-F 10:30am - 7pm
Work Environment: Remote
Total earnings may also include various incentive options. Actual pay will be adjusted based on experience, education, geographic location, and other job-related factors as permitted by law. Subject to program eligibility, this position qualifies for a robust suite of benefits including: Paid Time Off, a 401(k) program, Health Insurance including Dental &amp; Vision coverage, Tuition Reimbursement, Health Savings Account, and an Employee Assistance Program.
EmpiRx Health is an Equal Opportunity Employer
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we serve, where everyone is welcome and celebrated. We're not just breaking down barriers; we're actively erasing them to create an environment where opportunity knows no bounds. In unity, we find our strength and invite individuals from all walks of life to join us in our exhilarating journey to shape a brighter, more inclusive future together.</div>

Clinical Operations Specialist

Join Empirx Health and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Empirx Health

About Company

Per Diem Pharmacist

Clinical Operations Specialist