Description
Who We Are – Motivated by Purpose. Powered by Clinical Expertise.
Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.
Excellence starts with our people.
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
Our Pharmacy Entry Coordinator is responsible for carrying out day-to-day departmental tasks and completing 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, issuing appropriate, timely and accurate review outcome notifications and completion of pharmacy case review data in the online case summary/tracking system.
Roles:
- To prepare high quality, complete packets of appropriate pharmacy case review information and materials for submission to the Panel 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 packet for reviewers
- Identify appropriate reviewers for pharmacy case review assignment including determining their availability for a review assignment and obtaining 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
- Coordinate phone consultations between reviewers and practitioners/providers/facilities that are party to a review case as applicable
- Monitor client queues and daily assignments to ensure client timelines are met
- Effectively communicate with team members, supervisors and other departments
- Respond to inquiries from clients, other entities referring pharmacy cases for review and practitioners/providers/facilities
- Evaluate opinions submitted by Reviewers upon conclusion of their reviews for compliance with company standards for completeness
- Follow-up with Reviewers whose submitted opinions do not meet all compliance standards
- 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
- Actively participate in Pharmacy On Call rotation policy to meet client needs
- Actively participate in Pharmacy Saturday shift rotation policy to meet client needs
- Maintain and manage personnel production, quality and other benchmarks
- Support all Quality Management initiatives
- Actively participate in the Complaint Process and Provider Relations assessment process
- Support all Compliance Program activities
- Adhere to all policies and procedures
- Take feedback and responsibility for performance
- Adapt to the differences of clients
- Participate in all company meetings and committees as requested
- Maintain a flexible schedule to meet client needs
- Complete other duties and responsibilities as directed
Position Levels:
Each level attained compounds responsibilities with those of prior levels. For details, please reference career pathing documents.
In general, Coordinator I-IV:
- Training period to last from date of hire to an estimated 6 months
- Production should increase regularly, with expected career path benchmarks
- Quality should increase regularly, with expected career path benchmarks
- Adherence to all policies and procedures
- Takes feedback and responsibility for performance
- Adapts to the differences of clients
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
- Personal computer literacy and high competency in use of Microsoft Word, Microsoft Excel, and Adobe
- 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
- Strong working knowledge of medical insurance terminology and processes
- Strong working knowledge of prescription drug terminology
- 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 Statement:
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.
Drug-Free Workplace:
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. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.
California Consumer Privacy Act (CCPA) Information (California Residents Only):
- Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
- Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.
