Clinical Support Specialist
Location: Altoona, WI
Job Type: FullTime, Hourly
The Clinical Support Specialist will work as part of the clinical team to assist with administrative processes to ensure internal and external client’s needs are met in a timely and effective manner. This position will support clinical pharmacists and other staff with coverage determinations, specialty pharmacy benefit, clinical programs, and development of clinical support materials.
- Assist clinical pharmacist in administration duties related to utilization management processes (ex. prior authorizations)
- Effectively communicate with member and providers regarding utilization management decisions and general polices.
- Assist clinical pharmacists in proactive specialty pharmacy utilization management.
- Serve as a facilitator between clients, providers, members, and specialty pharmacies in administration of specialty benefit.
- Assist Client Support Specialist in managing specialty medications for PACE and Medicare Part D clients.
- Assist clinical pharmacists in development, management, and administration of clinical program.
- Assist clinical pharmacist in development of clinical materials for use in P&T, educational forums, and marketing materials.
- Develop and implement member communication materials.
- Work with Client Support Coordinator to ensure client reporting requirements are met.
- Assist with answering Help Desk calls when needed.
- Communicate applicable drug benefit policies to all clients (members, pharmacies, plan administrators and clinicians).
- Document all incoming calls and dialogue in the claims adjudication software.
- Address and resolve client drug benefit concerns of a medical, financial, or technological nature.
- Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
- Associates degree in a related field or equivalent experience.
- Ability to solve problems based on the analysis of data.
- Detailed oriented and able to prioritize workload.
- Computer skills including using word processors, spreadsheets, and databases (Microsoft Word & Excel preferred).
- Knowledge of healthcare or insurance preferred.
- Excellent technical and communication skills.
This position offers an outstanding benefit package, including three weeks of PTO the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and dedicated to providing exceptional service submit your resume today!
How do I Apply?
To apply for the Clinical Support Specialist position, please send your resume and cover letter to the
director of Human Resources & Culture in an email to firstname.lastname@example.org.
Pharmastar and KMTSJ, Inc. are affirmative action and equal opportunity employers.