Clinical Specialist I

POSITION SUMMARY

This position reports to the Clinical Specialist II - Formulary. The Clinical Specialist I – Formulary will develop and maintain formularies based on company and/or client rules. This individual will assist with daily clinical formulary operations, ensure compliance, and provide clinical, and operations support for planning, creating, maintaining, and reviewing formularies and utilization management restrictions.

ESSENTIALS ROLES AND RESPONSIBILITIES

1. Develop and maintain formularies based on company and/or client rules in OneArk’s Cube formulary tool and claims processing system.

2. Keep accurate formularies in PharmPix systems based on MediSpan and OneArk weekly drug update reports, OneArk monthly over-the-counter (OTC) update reports, bimonthly Pharmacy & Therapeutics (P&T) Committee decision reports, and client formulary change implementation requests.

3. Attend to daily clinical formulary operations, ensure compliance with all clients’ formulary policies and regulations, and provide clinical and operations support across cross-functional teams.

4. Assist the Formulary Manager to analyze new drugs, verify formulary changes, and reevaluate applicable drugs.

5. Perform marketing material update and development duties.

6. Comply with all the stipulations of the formulary marketing materials of all clients.

7. Help the Formulary Manager maintain the relationship with PharmPix clients, including reports of formulary changes to clients, formulary change testing, formulary change fax blast to pharmacies, and web posting for patients of applicable formulary changes.

8. Help create, revise, and improve policies, procedures, data, and new programs about related (Medicare Part D, Commercial, etc.) programs.

9. Special projects and/or other duties assigned by the Formulary Manager or designee.

10. Participate and provide administrative support to the P&T committee.

11. Assist the Coverage Determination or Clinical Programs areas as needed.

This position allows for a career ladder progression with the levels of Clinical Specialist II and Clinical Specialist III positions.

TRAINING & EDUCATION

• High-school diploma

• Pharmacy Technician Associate Degree from an accredited institution (where mandated by law)

LICENSURE / CERTIFICATION

• Nationally Certified Pharmacy Technician (CPhT) required.

• Current, valid, and unrestricted state or Puerto Rico Pharmacy Technician license/registry certificate.

PROFESSIONAL EXPERIENCE

• 1 – 2 years clinical experience in a health care environment or at a pharmacy benefit manager.

• Open to newly licensed technicians.

PROFESSIONAL COMPETENCIES

Knowledge:

• General knowledge of pharmacology for major drug categories.

• Knowledge of Microsoft Access, Word, Excel, PowerPoint, and Outlook, as well as Internet Explorer.

• Knowledge of pharmaceutical products, drug names (brand/generics), dosage forms, and pharmacy terminology.

• Knowledge of Retail Pharmacy Operations and an understanding of insurance billing, third-party systems, point of sale, online pharmacy claims processing system experience preferred.

• Knowledge of the purpose, organization, and policies of community health care delivery and pharmacy regulations/regulatory agencies.

Skills:

• Excellent phone, written, listening, and follow-through skills.

• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.

• Skill in exercising judgment in applying, interpreting, and coordinating departmental policies and procedures.

• Strong analytical, customer service, problem analysis, decision-making, and verbal and written communications skills.

• Time Management Skills: Skill in establishing priorities and accomplishing tasks promptly.

Abilities:

• A demonstrated ability to establish and maintain quality control standards.

• Ability to accurately read and interpret physicians’ prescription orders, medical charts, and diagnostic test and laboratory results.

• Ability to calculate figures, rates, ratios, percentages, and amounts in all units of measure using whole numbers, fractions, and decimals.

• Ability to develop and maintain productive relationships with other internal departments, PharmPix clients, and other health care professionals.

• Ability to learn and convey medical and formulary technical information at the level of the client, member, or healthcare professional.

• Ability to follow guidelines for accurate member interventions while meeting or exceeding performance standards.

• Ability to organize and integrate organizational priorities and deadlines.

• Ability to prioritize, check for errors, and spot inaccuracies.

• Ability to see trends in utilization patterns.

• Ability to solve practical problems and deal with a variety of standards effectively using good problem solving and analytical skills.

• Ability to understand the importance of and maintain the confidentiality of all patient information.

• Fully bilingual English and Spanish (preferred).

PharmPix is an Equal Employment Opportunity Employer Minorities / Females / Disable / Veterans