Clinical Pharmacy Coordinator

About the Company

Since 1983, this organization has been a clinically-focused, technology-enabled utilization management service provider offering expert clinical assessments, regulatory advice, and actionable insights to healthcare entities.

They emphasize excellence by investing in their workforce.

Compensation and Benefits

• Competitive salary package.
• Healthcare, vision, and dental insurance coverage.
• Generous 401(k) matching program.
• Paid time off including vacation, personal days, and holidays.
• Opportunities for professional growth and training.
• A collaborative team environment including fun events and prizes throughout the year.

Role Overview

The Clinical Pharmacy Coordinator is accountable for daily departmental activities involving screening incoming pharmacy review requests, organizing review materials for reviewers, documenting case review data in tracking systems, evaluating reviewer decisions, conducting outreach calls for additional details, handling inbound calls from medical professionals, delivering timely review notifications, and maintaining accurate client and case data.

Key Roles and Duties

• Prepare detailed and suitable pharmacy case review materials for reviewers.
• Complete the pharmacy case review cycle and communicate outcomes to relevant stakeholders.
• Act as liaison between the company, clients, reviewers, and healthcare providers involved in case reviews.
• Screen review requests to verify completeness of case materials.
• Organize and distribute documentation necessary for comprehensive pharmacy case evaluations.
• Select appropriate reviewers, confirm their availability, and facilitate case assignments.
• Engage clients to clarify inquiries, obtain additional case materials, and resolve issues.
• Respond to reviewer requests for supplementary data and notify clients and departments accordingly.
• Conduct outreach via phone and fax to gather missing information essential for clinical decisions.
• Respond to incoming calls from medical professionals regarding case status or updates.
• Create and maintain case files for active pharmacy reviews.
• Address queries from clients, referral sources, and providers.
• Deliver verbal and written review outcome notifications ensuring compliance with timing, content, and accuracy standards.
• Research client questions about review procedures or decisions.
• Identify needs for further information or review and notify clients and internal teams.
• Support quality management, compliance, and provider relations processes.
• Participate in relevant meetings, committees, and company initiatives.
• Follow all company policies and procedures and adapt to client-specific requirements.
• Maintain flexibility in scheduling to meet client demands.
• Collaborate and cross-train within teams as necessary.

Skills and Experience Requirements

• Preferably at least one year of prior pharmacy experience.
• Ideally one year in health insurance, healthcare, or managed care operations.
• Capability to perform in a fast-paced environment managing multiple priorities and meeting deadlines.
• Self-driven with minimal supervision required.
• Highly adaptable to dynamic workplace changes and shifting priorities.
• Proficient in Microsoft Word and personal computer use.
• Strong organizational skills with a focus on detail accuracy.
• Excellent verbal and written communication abilities.
• Effective training skills.
• Desirable knowledge of anatomy, physiology, medical, insurance, and prescription drug terminology.
• Critical thinking with meticulous attention to detail.
• Outstanding customer service aptitude.
• In-depth understanding of clients, products, workflows, regulatory obligations, and accreditation standards.

Education

High school diploma or equivalent required.

Work Environment and Additional Details

The position involves using a computer, phone, and office equipment while seated. This role is fully remote.

Diversity and Equal Opportunity

The employer values diversity and ensures all eligible applicants receive consideration regardless of race, color, religion, sex, age, national origin, veteran status, disability, sexual orientation, gender identity, marital or genetic factors, or any other legally protected characteristic.

Compliance and Drug-Free Policy

Employment is contingent on passing background and drug screenings. Employees must comply with HIPAA and company policies concerning confidentiality and security of sensitive health data.

California Privacy Note

• Applicants’ sensitive personal data may be collected, including identifying details and contact information.
• Applicants may access and request corrections to their data by contacting the company.