About the position
As a Clinical Reviewer (ICR) at Prime Therapeutics, you will play a crucial role in the development and implementation of medical pharmacy solutions programs. Your primary focus will be on supporting drug utilization review (DUR) efforts by analyzing physician prescribing patterns and consulting with physicians to ensure adherence to evidence-based best practices. You will work closely with internal teams to refine medical pharmacy management solutions and provide expert consultation on pharmacy issues to clinical operations representatives. This position requires regular discussions with practicing physicians and other prescribers regarding the prescribing of specialty medications, ensuring that our customers receive the highest quality of care. In this role, you will be responsible for reviewing and monitoring prescription claims data, identifying outlier prescribing practices, and conducting telephonic consultations with physicians to provide coaching on these practices. You will document your consultations and track intervention attempts according to operational procedures, contributing to the continuous improvement of our pharmacy programs. Your collaboration with various departments, including operations, clinical, and medical teams, will be essential in maintaining the integrity of our pharmaceutical solutions and ensuring effective communication with prescribers. Additionally, you will uphold the clinical integrity of our pharmacy programs by staying informed about the latest medication information and best practices. Your contributions will not only enhance the operational efficiency of the pharmacy team but also support the overall mission of Prime Therapeutics to help people get the medicine they need to feel better and live well. This position offers the opportunity to make a significant impact in the healthcare industry while working in a fast-paced and dynamic environment.
Responsibilities
- Regularly review and monitor prescription claims data and prescribing practices identified as outliers.
- Contact physicians and prescribers needing consultation to provide coaching on identified outlier prescribing practices.
- Review prior authorizations and determine opportunities for interventions.
- Track contact attempts and document the content and results of consultations as defined in operations procedures.
- Collaborate on the refinement of consultation scripting and solicit input for improvements.
- Assist with the implementation and management of communications to physicians and prescribers.
- Contribute to program improvements using continuous quality improvement processes.
- Stay up-to-date on medication information and collaborate with Medical Directors and Clinical Departments.
Requirements
- 5 years' experience in clinical pharmacy with emphasis in specialty pharmacy and oncology.
- Managed care pharmaceutical service experience with coaching physicians on medication issues.
- Knowledge of current research related to specialty medications.
- Strong research and implementation skills in practical settings.
- Analytical skills for practical recommendations.
- Strong team orientation and respect for all members.
- Strong verbal and written communication skills.
- People skills for successful consultation with physicians and collaboration with team members.
- Comfortable using computers and the internet; basic skills with Microsoft Office products.
Nice-to-haves
- Managed care experience preferred.
- Experience with pharmaceuticals in a pharmaceutical sales, retail, or managed care environment preferred.
- Management experience in coordinating and collaborating with work teams preferred.
- Experience with managed pharmacy benefits organizations preferred.
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- 401k retirement plan
- Paid holidays
- Paid time off (PTO)
- Tuition reimbursement
- Flexible scheduling options
- Employee discount programs
- Professional development opportunities
