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Manager Business Finance

Health Dialog

Manager Business Finance

San Antonio, TX
Full Time
Paid
  • Responsibilities

    Health Dialog is seeking a CLINICAL PHARMACIST to support the day-to-day functions, development and enhancement of services offered to our members through all clinical programs, including coordination of pain management, patient safety, adherence, medication therapy management (MTM) and care management.

     

    The associate is responsible for the functions below, in addition to other duties as assigned:

    • Finalize clinical case reviews and provide clinical oversight to patient safety, controlled substances utilization, MTM and care management programs

    • Handle approval and denial decisions for coverage determination and redetermination requests, including but not limited to prior authorization requests, quantity limit exceptions, non-formulary exception requests, step therapy exception requests, tier exceptions and maximum dollar overrides in accordance with Medicare and Medicaid guidelines, client guidelines, and benefit designs

    • Provide clinical expertise and utilize decision making skills to evaluate and discuss MTM with members, while collaborating with prescribers. Handling patient calls such as medication review, reconciliation and adherence for a variety of clients and programs to meet performance and quality standards and program goals.

    • Analyze drug usage and CMS required reports to identify areas of improvement and recommend solutions in accordance with internal policies, state regulations, national regulations, and recognized national quality metrics

    • Participate in required trainings as assigned and support security and compliance related activities and task throughout execution of all job duties

     

    QUALIFICATION REQUIREMENTS

    To perform this job successfully, the associate must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required:

    • Bachelor’s Degree in Arts/Sciences (BA/BS) Pharmacy or Pharm D with license required.

    • 2 years of experience in working as a registered pharmacist in a clinical or PBM setting required.

    • 1 year of experience in one or more of the following: managed care, utilization management, case management, disease management, or formulary management. preferred.

    • Active Pharmacist license in good standing for the state in which one works and eligible for licensure in additional states required

    • Demonstrated knowledge and experience in Medicare Part D and Medicaid

    • Excellent verbal and written skills

    • Technology savvy; experience using Windows-based software including the Microsoft Office suite

     

    LOCATION: This position is a remote position working from your home. Candidates must be located in the US.

     

    SCHEDULE: This position is a salaried/exempt role generally working 9:00 am to 5:30 pm Eastern Time.

     

    Health Dialog is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, sexual orientation, gender identity, race, age, disability, religion, national origin, color or other category protected by applicable law.

    Required Skills Required Experience